Healthcare Provider Details
I. General information
NPI: 1780817841
Provider Name (Legal Business Name): MS. PHOEBE SUEHIRO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y
II. Dates (important events)
Enumeration Date: 08/24/2009
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
310 8TH ST 201
OAKLAND CA
94607-6526
US
IV. Provider business mailing address
310 8TH ST 201
OAKLAND CA
94607-6526
US
V. Phone/Fax
- Phone: 510-869-6000
- Fax:
- Phone: 510-869-6000
- Fax:
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 171M00000X |
| Taxonomy | Case Manager/Care Coordinator |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name:
Title or Position:
Credential:
Phone: