Healthcare Provider Details

I. General information

NPI: 1568100303
Provider Name (Legal Business Name): MICHAEL ABROGAR
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 05/23/2022
Certification Date: 05/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1124 INTERNATIONAL BLVD
OAKLAND CA
94606-4331
US

IV. Provider business mailing address

1124 INTERNATIONAL BLVD
OAKLAND CA
94606-4331
US

V. Phone/Fax

Practice location:
  • Phone: 510-533-0800
  • Fax:
Mailing address:
  • Phone: 510-533-0800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN95176025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: