Healthcare Provider Details

I. General information

NPI: 1073446449
Provider Name (Legal Business Name): JAMAAL R GARY RN
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/05/2026
Last Update Date: 06/05/2026
Certification Date: 06/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2633 E 27TH ST
OAKLAND CA
94601-1912
US

IV. Provider business mailing address

2010 MONTEREY CIR APT C
ALAMEDA CA
94501-7531
US

V. Phone/Fax

Practice location:
  • Phone: 510-536-8111
  • Fax:
Mailing address:
  • Phone: 860-970-2798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number95363568
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number95363568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: