Healthcare Provider Details

I. General information

NPI: 1417824145
Provider Name (Legal Business Name): MR. MARVIN TYRRELL FINCH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2025
Last Update Date: 10/18/2025
Certification Date: 10/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

337 13TH ST STE 203
OAKLAND CA
94612-3951
US

IV. Provider business mailing address

4645 SPRINGLAKE DR
SAN LEANDRO CA
94578-4834
US

V. Phone/Fax

Practice location:
  • Phone: 510-481-0908
  • Fax: 510-616-4126
Mailing address:
  • Phone: 510-703-4840
  • Fax: 510-616-4126

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT00065338
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: