Healthcare Provider Details

I. General information

NPI: 1649479759
Provider Name (Legal Business Name): CHILDREN'S HOSPITAL & RESEARCH CENTER OAKLAND
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2007
Last Update Date: 10/09/2007
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: 510-428-3461
  • Fax: 510-601-3461
Mailing address:
  • Phone: 510-428-3461
  • Fax: 510-601-3461

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License Number486649
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number486649
License Number StateCA

VIII. Authorized Official

Name: MR. FRANK TIEDEMANN
Title or Position: CEO & PRESIDENT
Credential: MBA
Phone: 510-428-3461