Healthcare Provider Details

I. General information

NPI: 1073769402
Provider Name (Legal Business Name): THE WEST OAKLAND HEALTH COUNCIL
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2008
Last Update Date: 05/17/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3007 TELEGRAPH AVE
OAKLAND CA
94609-3205
US

IV. Provider business mailing address

3007 TELEGRAPH AVE
OAKLAND CA
94609-3205
US

V. Phone/Fax

Practice location:
  • Phone: 510-422-1500
  • Fax:
Mailing address:
  • Phone: 510-422-1500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. BENJAMIN F. PETTUS
Title or Position: CEO
Credential:
Phone: 510-835-9610