Healthcare Provider Details

I. General information

NPI: 1609327907
Provider Name (Legal Business Name): ANN MARTIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 10/21/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2629 HARRISON ST
OAKLAND CA
94612-3813
US

IV. Provider business mailing address

2629 HARRISON ST
OAKLAND CA
94612-3813
US

V. Phone/Fax

Practice location:
  • Phone: 510-655-7880
  • Fax: 510-655-3379
Mailing address:
  • Phone: 510-655-7880
  • Fax: 510-655-3379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number140000152
License Number StateCA

VIII. Authorized Official

Name: DR. HASSE LEONARD-PAGEL
Title or Position: DIRECTOR OF CLINICAL PROGRAMS
Credential: PH.D.
Phone: 510-655-7880