Healthcare Provider Details

I. General information

NPI: 1790381564
Provider Name (Legal Business Name): ASHLEY JOSEPHSON CPO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/08/2020
Last Update Date: 12/08/2020
Certification Date: 11/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 HEGENBERGER RD STE 100
OAKLAND CA
94621-1448
US

IV. Provider business mailing address

433 HEGENBERGER RD STE 100
OAKLAND CA
94621-1448
US

V. Phone/Fax

Practice location:
  • Phone: 510-430-2500
  • Fax:
Mailing address:
  • Phone: 510-430-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code222Z00000X
TaxonomyOrthotist
License NumberCPO03677
License Number StateMN
# 2
Primary TaxonomyN
Taxonomy Code224P00000X
TaxonomyProsthetist
License NumberCPO03677
License Number StateMN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: