Healthcare Provider Details

I. General information

NPI: 1215858386
Provider Name (Legal Business Name): WALTER E B SIPE MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2026
Last Update Date: 07/23/2026
Certification Date: 07/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1425 LEIMERT BLVD STE 204
OAKLAND CA
94602-1866
US

IV. Provider business mailing address

1425 LEIMERT BLVD STE 204
OAKLAND CA
94602-1866
US

V. Phone/Fax

Practice location:
  • Phone: 415-483-2112
  • Fax: 415-744-1163
Mailing address:
  • Phone: 415-483-2112
  • Fax: 415-744-1163

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: WALTER E.B. SIPE
Title or Position: PRESIDENT
Credential: MD
Phone: 415-483-2112