Healthcare Provider Details

I. General information

NPI: 1871780981
Provider Name (Legal Business Name): JEANETTE C ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/02/2007
Last Update Date: 10/02/2007
Certification Date:
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 Code225000000X
TaxonomyOrthotic Fitter
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: