Healthcare Provider Details

I. General information

NPI: 1699928333
Provider Name (Legal Business Name): KAISER PERMANENTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2008
Last Update Date: 10/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3505 BROADWAY
OAKLAND CA
94611-5714
US

IV. Provider business mailing address

3505 BROADWAY
OAKLAND CA
94611-5714
US

V. Phone/Fax

Practice location:
  • Phone: 510-752-1851
  • Fax:
Mailing address:
  • Phone: 510-752-1851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License NumberPT15860
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberPT15860
License Number StateCA

VIII. Authorized Official

Name: MS. SHARON TREPPA WHITE
Title or Position: PHYSICAL THERAPIST/PEDIATRIC SP.
Credential: P.T.
Phone: 510-752-1851