Healthcare Provider Details

I. General information

NPI: 1699856039
Provider Name (Legal Business Name): MARIJKE BARBARA HALLBERG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/18/2006
Last Update Date: 10/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

747 52ND STREET (ED-II)
OAKLAND CA
94609-1809
US

IV. Provider business mailing address

747 52ND STREET (ED-II)
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 510-628-3522
  • Fax: 510-450-5696
Mailing address:
  • Phone: 510-628-3522
  • Fax: 510-450-5696

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code282NC2000X
TaxonomyChildren's Hospital
License NumberA65568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: