Healthcare Provider Details

I. General information

NPI: 1932582921
Provider Name (Legal Business Name): RICHARD STANLEY R.N.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/08/2015
Last Update Date: 07/08/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

510 17TH ST STE 400
OAKLAND CA
94612-1570
US

IV. Provider business mailing address

510 17TH ST STE 400
OAKLAND CA
94612-1570
US

V. Phone/Fax

Practice location:
  • Phone: 510-433-1150
  • Fax:
Mailing address:
  • Phone: 510-433-1150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP2201X
TaxonomyAmbulatory Care Registered Nurse
License Number592176
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: