Healthcare Provider Details

I. General information

NPI: 1598440091
Provider Name (Legal Business Name): SAMUEL DARREN BOSCH MD, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/21/2023
Last Update Date: 07/02/2026
Certification Date: 07/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3451 E 12TH ST
OAKLAND CA
94601-3463
US

IV. Provider business mailing address

3451 E 12TH ST
OAKLAND CA
94601-3463
US

V. Phone/Fax

Practice location:
  • Phone: 925-370-5117
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA197511
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: