Healthcare Provider Details

I. General information

NPI: 1669615985
Provider Name (Legal Business Name): ARI MAX BACHRACH NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/16/2009
Last Update Date: 10/25/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 BELLEVUE AVE STE 101C
OAKLAND CA
94610-4923
US

IV. Provider business mailing address

445 BELLEVUE AVE STE 101C
OAKLAND CA
94610-4923
US

V. Phone/Fax

Practice location:
  • Phone: 510-269-7609
  • Fax:
Mailing address:
  • Phone: 415-710-0992
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number746882
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number23352
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: