Healthcare Provider Details

I. General information

NPI: 1588806996
Provider Name (Legal Business Name): PRESCOTT-JOSEPH CENTER FOR COMMUNITY ENHANCEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2009
Last Update Date: 03/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 PERALTA ST
OAKLAND CA
94607-1926
US

IV. Provider business mailing address

920 PERALTA ST
OAKLAND CA
94607-1926
US

V. Phone/Fax

Practice location:
  • Phone: 510-208-5651
  • Fax: 510-208-2801
Mailing address:
  • Phone: 510-208-5651
  • Fax: 510-208-2801

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207KA0200X
TaxonomyAllergy Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. WASHINGTON BURNS
Title or Position: EXECUTIVE DIRECTOR
Credential: M.D.
Phone: 510-208-5651