Healthcare Provider Details

I. General information

NPI: 1629301445
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL & RESEARCH CENTER OAKLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2009
Last Update Date: 09/11/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

2285 BAY ST APT 10
SAN FRANCISCO CA
94123-1823
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3885
  • Fax:
Mailing address:
  • Phone: 661-313-5805
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QS1000X
TaxonomyStudent Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. JUDITH LIBOW
Title or Position: DIRECTOR OF MENTAL HEALTH SERICES
Credential: PH.D
Phone: 510-428-3885