Healthcare Provider Details

I. General information

NPI: 1164759544
Provider Name (Legal Business Name): BETH DILLIN BETH DILLIN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/05/2009
Last Update Date: 11/05/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3701 BROADWAY MEDICAL OFFICE BUILDING, SECOND FLOOR 201
OAKLAND CA
94611-5613
US

IV. Provider business mailing address

2943 SOUTHWOOD DR
ALAMEDA CA
94501-1751
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-6561
  • Fax:
Mailing address:
  • Phone: 925-577-1696
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number1617
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: