Healthcare Provider Details

I. General information

NPI: 1386838332
Provider Name (Legal Business Name): DR. CHERYL ELACIO LEE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2007
Last Update Date: 07/11/2026
Certification Date: 07/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 E 16TH ST
OAKLAND CA
94601-2319
US

IV. Provider business mailing address

1556 FITZGERALD DR # 208
PINOLE CA
94564-2229
US

V. Phone/Fax

Practice location:
  • Phone: 510-535-4700
  • Fax:
Mailing address:
  • Phone: 415-948-6416
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number56243
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: