Healthcare Provider Details

I. General information

NPI: 1851117618
Provider Name (Legal Business Name): MR. ALFRED C FAIRLEY
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/26/2024
Last Update Date: 11/27/2024
Certification Date: 11/26/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 BANCROFT AVE STE 133
OAKLAND CA
94605-2480
US

IV. Provider business mailing address

7200 BANCROFT AVE STE 133
OAKLAND CA
94605-2480
US

V. Phone/Fax

Practice location:
  • Phone: 510-859-6700
  • Fax:
Mailing address:
  • Phone: 510-859-6700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: