Healthcare Provider Details

I. General information

NPI: 1952942575
Provider Name (Legal Business Name): ROOTS COMMUNITY HEALTH CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/04/2019
Last Update Date: 10/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

583 5TH ST STE A
OAKLAND CA
94607
US

IV. Provider business mailing address

9925 INTERNATIONAL BLVD #5
OAKLAND CA
94603-2558
US

V. Phone/Fax

Practice location:
  • Phone: 510-839-0929
  • Fax: 510-788-6837
Mailing address:
  • Phone: 510-777-1177
  • Fax: 510-550-2644

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: NOHA M ABOELATA
Title or Position: CEO
Credential: MD
Phone: 510-777-1177