Healthcare Provider Details

I. General information

NPI: 1609121052
Provider Name (Legal Business Name): BABY BUILDERS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/20/2012
Last Update Date: 08/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4341 PIEDMONT AVE SUITE #3
OAKLAND CA
94611-4766
US

IV. Provider business mailing address

4341 PIEDMONT AVE SUITE #3
OAKLAND CA
94611-4766
US

V. Phone/Fax

Practice location:
  • Phone: 510-333-4579
  • Fax: 510-740-3491
Mailing address:
  • Phone: 510-333-4579
  • Fax: 510-740-3491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number11902
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number11902
License Number StateCA

VIII. Authorized Official

Name: MRS. GRACIELA PAGANO
Title or Position: PROGRAM DIRECTOR
Credential: PT
Phone: 510-333-4579