Healthcare Provider Details

I. General information

NPI: 1588491930
Provider Name (Legal Business Name): SHANTESHA SOLONIA-LUVLONDA FLUKER MPSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/18/2024
Last Update Date: 03/31/2026
Certification Date: 03/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1503 8TH ST
OAKLAND CA
94607-1964
US

IV. Provider business mailing address

1503 8TH ST
OAKLAND CA
94607-1964
US

V. Phone/Fax

Practice location:
  • Phone: 510-772-4798
  • Fax:
Mailing address:
  • Phone: 510-772-4798
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-SXFVYD
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number25445
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: