Healthcare Provider Details

I. General information

NPI: 1255621389
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL & REASEARCH CENTER OAKLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND STREET
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:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number16405
License Number StateCA

VIII. Authorized Official

Name: SARA TALAMANTEZ
Title or Position: SPEECH - LANGUAGE PATHOLOGIST
Credential:
Phone: 510-428-3885