Healthcare Provider Details

I. General information

NPI: 1497832323
Provider Name (Legal Business Name): ELOUISE JOSEPH MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/31/2006
Last Update Date: 11/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4180 PARK BLVD
OAKLAND CA
94602-1207
US

IV. Provider business mailing address

4180 PARK BLVD
OAKLAND CA
94602-1207
US

V. Phone/Fax

Practice location:
  • Phone: 510-530-5437
  • Fax:
Mailing address:
  • Phone: 510-652-5161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG47239
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: