Healthcare Provider Details

I. General information

NPI: 1508778440
Provider Name (Legal Business Name): SHANEKA RAFAELA
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2026
Last Update Date: 09/17/2026
Certification Date: 09/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2221 MARTIN LUTHER KING JR WAY
OAKLAND CA
94612-1318
US

IV. Provider business mailing address

PO BOX 64
SAN LEANDRO CA
94577-0006
US

V. Phone/Fax

Practice location:
  • Phone: 510-267-7800
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number701167
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: