Healthcare Provider Details

I. General information

NPI: 1710828215
Provider Name (Legal Business Name): TARA MARIE ANTONE-MCDONALD CMT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2026
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

407 PERKINS ST APT 305
OAKLAND CA
94610-4716
US

IV. Provider business mailing address

407 PERKINS ST APT 305
OAKLAND CA
94610-4716
US

V. Phone/Fax

Practice location:
  • Phone: 510-302-8901
  • Fax:
Mailing address:
  • Phone: 510-302-8901
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number48073
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: