Healthcare Provider Details

I. General information

NPI: 1437439437
Provider Name (Legal Business Name): DANIEL SEBASTIEN VAN BEEK B.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/22/2011
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

255 INTERNATIONAL BLVD
OAKLAND CA
94606-2235
US

IV. Provider business mailing address

6620 DOVER ST
OAKLAND CA
94609-1012
US

V. Phone/Fax

Practice location:
  • Phone: 510-835-2777
  • Fax:
Mailing address:
  • Phone: 916-849-8939
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: