Healthcare Provider Details

I. General information

NPI: 1508876194
Provider Name (Legal Business Name): JAMES MITTELBERGER M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/08/2006
Last Update Date: 11/10/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6155 GIRVIN DR
OAKLAND CA
94611-2444
US

IV. Provider business mailing address

6155 GIRVIN DR
OAKLAND CA
94611-2444
US

V. Phone/Fax

Practice location:
  • Phone: 510-387-0585
  • Fax: 510-291-2970
Mailing address:
  • Phone: 510-387-0585
  • Fax: 510-291-2970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberG58513
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: