Healthcare Provider Details

I. General information

NPI: 1659152031
Provider Name (Legal Business Name): PUBLIC HEALTH INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 12TH ST STE 600
OAKLAND CA
94607-4067
US

IV. Provider business mailing address

555 12TH ST STE 600
OAKLAND CA
94607-4067
US

V. Phone/Fax

Practice location:
  • Phone: 510-285-5500
  • Fax: 510-285-5501
Mailing address:
  • Phone: 510-285-5500
  • Fax: 510-285-5501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: DARNESHIA S. BLACKMON
Title or Position: DIRECTOR OF BID AND PROPOSAL
Credential:
Phone: 510-285-5742