Healthcare Provider Details

I. General information

NPI: 1174040877
Provider Name (Legal Business Name): WENDY AHUMADA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/24/2017
Last Update Date: 08/24/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 ROLAND WAY STE 100
OAKLAND CA
94621-2034
US

IV. Provider business mailing address

153 HAAS AVE
SAN LEANDRO CA
94577-3717
US

V. Phone/Fax

Practice location:
  • Phone: 510-746-2800
  • Fax: 510-746-2810
Mailing address:
  • Phone: 510-459-9481
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: