Healthcare Provider Details

I. General information

NPI: 1396075784
Provider Name (Legal Business Name): HEALTHY OAKLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/06/2010
Last Update Date: 01/06/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2580 SAN PABLO AVE
OAKLAND CA
94612-1160
US

IV. Provider business mailing address

2580 SAN PABLO AVE
OAKLAND CA
94612-1160
US

V. Phone/Fax

Practice location:
  • Phone: 510-444-9155
  • Fax:
Mailing address:
  • Phone: 510-444-9155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License NumberNP 15577
License Number StateCA

VIII. Authorized Official

Name: CYNTHIA COOPER
Title or Position: CLINICAL MANAGER
Credential: CLINICAL MANAGER
Phone: 510-444-9155