Healthcare Provider Details

I. General information

NPI: 1629133079
Provider Name (Legal Business Name): MICHAEL IOCCA D.O.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/26/2006
Last Update Date: 09/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST
OAKLAND CA
94602-1092
US

IV. Provider business mailing address

7677 OAKPORT ST STE 1200
OAKLAND CA
94621-1975
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4893
  • Fax: 510-379-7440
Mailing address:
  • Phone: 510-437-4893
  • Fax: 510-379-7440

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number20A6072
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: