Healthcare Provider Details

I. General information

NPI: 1770084816
Provider Name (Legal Business Name): NAOMI SIMONE BANKS MENARD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/23/2018
Last Update Date: 10/14/2021
Certification Date: 10/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1999 HARRISON ST STE 1800
OAKLAND CA
94612-4700
US

IV. Provider business mailing address

623 ATHENS ST
SAN FRANCISCO CA
94112-3530
US

V. Phone/Fax

Practice location:
  • Phone: 916-597-7166
  • Fax:
Mailing address:
  • Phone: 808-203-7792
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: