Healthcare Provider Details

I. General information

NPI: 1497621262
Provider Name (Legal Business Name): SOFIA GONZALEZ ASTARLOA
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2025
Last Update Date: 10/16/2025
Certification Date: 10/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE STE 188
OAKLAND CA
94605-2452
US

IV. Provider business mailing address

2701 SHATTUCK AVE APT 300
BERKELEY CA
94705-1087
US

V. Phone/Fax

Practice location:
  • Phone: 510-746-5561
  • Fax:
Mailing address:
  • Phone: 510-684-9726
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code136A00000X
TaxonomyRegistered Dietetic Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: