Healthcare Provider Details

I. General information

NPI: 1275082158
Provider Name (Legal Business Name): TULLY NICOLE TAMPAKES ASW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2016
Last Update Date: 10/09/2020
Certification Date: 10/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3001 INTERNATIONAL BLVD
OAKLAND CA
94601-2203
US

IV. Provider business mailing address

3001 INTERNATIONAL BLVD
OAKLAND CA
94601-2203
US

V. Phone/Fax

Practice location:
  • Phone: 510-433-8600
  • Fax:
Mailing address:
  • Phone: 510-433-8600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code247000000X
TaxonomyHealth Information Technician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2470A2800X
TaxonomyAssistant Health Information Record Technician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number97432
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: