Healthcare Provider Details

I. General information

NPI: 1750428538
Provider Name (Legal Business Name): KARA HUTTON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 07/08/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

4627 BROOKDALE AVE
OAKLAND CA
94619-2507
US

V. Phone/Fax

Practice location:
  • Phone: 510-290-0148
  • Fax:
Mailing address:
  • Phone: 510-290-0148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA90565
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: