Healthcare Provider Details

I. General information

NPI: 1578921565
Provider Name (Legal Business Name): JOY OCTAVIANO MS, RN, AOCNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 02/04/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

275 W MACARTHUR BLVD
OAKLAND CA
94611-5641
US

IV. Provider business mailing address

1884 CONNOR WAY
BRENTWOOD CA
94513-7330
US

V. Phone/Fax

Practice location:
  • Phone: 510-301-1388
  • Fax:
Mailing address:
  • Phone: 925-325-1883
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WX0200X
TaxonomyOncology Registered Nurse
License Number652531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: