Healthcare Provider Details

I. General information

NPI: 1992838155
Provider Name (Legal Business Name): KARLA L MUNKACSY R.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 07/12/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 W MACARTHUR BLVD HOME HEALTH DEPT
OAKLAND CA
94611-5641
US

IV. Provider business mailing address

235 W MACARTHUR BLVD HOME HEALTH DEPT
OAKLAND CA
94611-5641
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-1341
  • Fax:
Mailing address:
  • Phone: 510-752-1341
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number387593
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: