Healthcare Provider Details

I. General information

NPI: 1447398896
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL AND RESEARCH CENTER AT OAKLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2007
Last Update Date: 07/10/2008
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: 510-428-3649
  • Fax: 510-601-3973
Mailing address:
  • Phone: 510-428-3649
  • Fax: 510-601-3973

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberPSY 19128
License Number StateCA

VIII. Authorized Official

Name: DR. CHERISE NORTHCUTT
Title or Position: MANAGER
Credential: PH.D.
Phone: 510-428-3885