Healthcare Provider Details

I. General information

NPI: 1346424983
Provider Name (Legal Business Name): DAVID MEDINA R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/18/2007
Last Update Date: 12/18/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE STE 202
OAKLAND CA
94605-2471
US

IV. Provider business mailing address

7200 BANCROFT AVE STE 202
OAKLAND CA
94605-2471
US

V. Phone/Fax

Practice location:
  • Phone: 510-577-7084
  • Fax: 510-273-3713
Mailing address:
  • Phone: 510-577-7084
  • Fax: 510-273-3713

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License Number379031
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: