Healthcare Provider Details

I. General information

NPI: 1922730795
Provider Name (Legal Business Name): DEVIKA GOPAL PATEL RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2022
Last Update Date: 06/30/2022
Certification Date: 06/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

747 52ND ST
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3885
  • Fax: 510-428-3381
Mailing address:
  • Phone: 510-428-3885
  • Fax: 510-428-3381

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number820706
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: