Healthcare Provider Details

I. General information

NPI: 1457816142
Provider Name (Legal Business Name): JULIE MA WILLKOM RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/06/2019
Last Update Date: 02/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 EAST 31ST STREET HIGHLAND CARE PAVILION, TB CLINIC, 5TH FLOOR
OAKLAND CA
94602
US

IV. Provider business mailing address

1411 EAST 31ST STREET ACT 1ST FLOOR, INFECTION CONTROL, ROOM 1703
OAKLAND CA
94602
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-6466
  • Fax: 510-535-7675
Mailing address:
  • Phone: 510-535-7701
  • Fax: 510-535-7675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number754149
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: