Healthcare Provider Details

I. General information

NPI: 1710177803
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL & RESEARCH CENTER AT OAKLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2007
Last Update Date: 04/02/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5275 CLAREMONT AVE.
OAKLAND CA
94609
US

IV. Provider business mailing address

747 52ND STREET
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3571
  • Fax:
Mailing address:
  • Phone: 510-428-3571
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. COLLEEN REID
Title or Position: CONTROLLER
Credential: CPA
Phone: 510-428-7605