Healthcare Provider Details

I. General information

NPI: 1235258328
Provider Name (Legal Business Name): REBECCA LADD EAKINS AUSTIN M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 BROADWAY
OAKLAND CA
94611-5714
US

IV. Provider business mailing address

6315 CHABOT RD
OAKLAND CA
94618-1614
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-1200
  • Fax:
Mailing address:
  • Phone: 510-547-2233
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA91784
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: