Healthcare Provider Details

I. General information

NPI: 1851435085
Provider Name (Legal Business Name): MRS. KATHERINE MOPPIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHERINE JOHNSON

II. Dates (important events)

Enumeration Date: 02/19/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2620 26TH AVE
OAKLAND CA
94601-1907
US

IV. Provider business mailing address

3359 ISHERWOOD WAY
FREMONT CA
94536-3566
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-2363
  • Fax: 510-437-2366
Mailing address:
  • Phone: 510-796-3397
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: