Healthcare Provider Details

I. General information

NPI: 1770413320
Provider Name (Legal Business Name): SUNDUS WAQIA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/22/2026
Last Update Date: 05/22/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1733 BROADWAY
OAKLAND CA
94612-2105
US

IV. Provider business mailing address

1827 108TH AVE
OAKLAND CA
94603-3909
US

V. Phone/Fax

Practice location:
  • Phone: 510-931-7569
  • Fax:
Mailing address:
  • Phone: 510-216-9477
  • 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: