Healthcare Provider Details

I. General information

NPI: 1821158874
Provider Name (Legal Business Name): LYDIA MAGAVERN SHRESTHA MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/11/2006
Last Update Date: 10/31/2023
Certification Date: 10/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST CHILDRENS HOSPITAL OAKLAND ED 2
OAKLAND CA
94609
US

IV. Provider business mailing address

1411 E 31ST ST
OAKLAND CA
94602-1018
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3000
  • Fax: 510-450-5696
Mailing address:
  • Phone: 510-437-5039
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA64853
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: