Healthcare Provider Details

I. General information

NPI: 1982882155
Provider Name (Legal Business Name): PAUL M EASTERWOOD BOC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2008
Last Update Date: 02/13/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 TELEGRAPH AVE
OAKLAND CA
94609-1310
US

IV. Provider business mailing address

6001 TELEGRAPH AVE
OAKLAND CA
94609-1310
US

V. Phone/Fax

Practice location:
  • Phone: 510-658-2062
  • Fax: 510-658-7779
Mailing address:
  • Phone: 510-658-2062
  • Fax: 510-658-7779

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: