Healthcare Provider Details

I. General information

NPI: 1215242318
Provider Name (Legal Business Name): BAY AREA DIABETES AND WELLNESS CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2010
Last Update Date: 01/31/2020
Certification Date: 01/31/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1904 FRANKLIN ST STE 250
OAKLAND CA
94612-2945
US

IV. Provider business mailing address

1904 FRANKLIN ST STE 250
OAKLAND CA
94612-2945
US

V. Phone/Fax

Practice location:
  • Phone: 510-922-8208
  • Fax:
Mailing address:
  • Phone: 510-922-8208
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133VN1006X
TaxonomyMetabolic Nutrition Registered Dietitian
License NumberR802608
License Number StateCA

VIII. Authorized Official

Name: ELIZABETH T LEONG
Title or Position: CEO
Credential: RD
Phone: 510-922-8208