Healthcare Provider Details

I. General information

NPI: 1093936841
Provider Name (Legal Business Name): JUNE MARIE TESTER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/01/2007
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND STREET
OAKLAND CA
94609
US

IV. Provider business mailing address

348 51ST STREET UNIT C
OAKLAND CA
94609
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3000
  • Fax:
Mailing address:
  • Phone: 510-652-2138
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA85565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: