Healthcare Provider Details

I. General information

NPI: 1639303118
Provider Name (Legal Business Name): IRYNA ANATOLIYEVNA FALKENSTEIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/12/2009
Last Update Date: 07/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

491 30TH ST STE 103
OAKLAND CA
94609
US

IV. Provider business mailing address

491 30TH ST STE 103
OAKLAND CA
94609-3235
US

V. Phone/Fax

Practice location:
  • Phone: 510-763-9775
  • Fax:
Mailing address:
  • Phone: 510-763-9775
  • Fax: 510-763-1501

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207WX0009X
TaxonomyGlaucoma Specialist (Ophthalmology) Physician
License NumberC145657
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number254349
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: