Healthcare Provider Details

I. General information

NPI: 1538072400
Provider Name (Legal Business Name): ALEJANDRO YANEZ MARMOLEJO LICENSED VOCATIONAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2131 104TH AVE
OAKLAND CA
94603-3337
US

IV. Provider business mailing address

2131 104TH AVE
OAKLAND CA
94603-3337
US

V. Phone/Fax

Practice location:
  • Phone: 510-695-1259
  • Fax:
Mailing address:
  • Phone: 510-695-1259
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License NumberVN757611
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: