Healthcare Provider Details

I. General information

NPI: 1013931104
Provider Name (Legal Business Name): HELENA BLACK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2107 LIVINGSTON STREET SUITE A
OAKLAND CA
94606
US

IV. Provider business mailing address

2107 LIVINGSTON STREET SUITE A
OAKLAND CA
94606
US

V. Phone/Fax

Practice location:
  • Phone: 510-436-9000
  • Fax: 510-436-9013
Mailing address:
  • Phone: 510-436-9000
  • Fax: 510-436-9013

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberG49132
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: