Healthcare Provider Details

I. General information

NPI: 1225161672
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL OAKLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2007
Last Update Date: 08/20/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND ST
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

747 52ND ST
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-428-3885
  • Fax: 510-601-3994
Mailing address:
  • Phone: 510-428-3885
  • Fax: 510-601-3994

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281PC2000X
TaxonomyChildren's Chronic Disease Hospital
License NumberLCS17542
License Number StateCA

VIII. Authorized Official

Name: MS. APRIL BOLIN
Title or Position: SOCIAL WORKER
Credential: L.C.S.W.
Phone: 510-428-3639