Healthcare Provider Details

I. General information

NPI: 1902364060
Provider Name (Legal Business Name): TERRI GRIFFIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/07/2019
Last Update Date: 03/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6955 FOOTHILL BLVD STE 200
OAKLAND CA
94605-2426
US

IV. Provider business mailing address

6955 FOOTHILL BLVD STE 200
OAKLAND CA
94605-2426
US

V. Phone/Fax

Practice location:
  • Phone: 510-567-5700
  • Fax: 510-568-3312
Mailing address:
  • Phone: 510-567-5700
  • Fax: 510-568-3312

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number49306
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: