Healthcare Provider Details

I. General information

NPI: 1164507240
Provider Name (Legal Business Name): OAKCARE MEDICAL GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2006
Last Update Date: 09/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST
OAKLAND CA
94602-1018
US

IV. Provider business mailing address

1411 E 31ST ST
OAKLAND CA
94602-1018
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4323
  • Fax: 510-437-5042
Mailing address:
  • Phone: 510-437-4323
  • Fax: 510-437-5042

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License NumberRN 33265
License Number StateCA

VIII. Authorized Official

Name: BARRY C. SIMON
Title or Position: EXECUTIVE DIRECTOR
Credential: MD
Phone: 510-437-4323