Healthcare Provider Details

I. General information

NPI: 1366431074
Provider Name (Legal Business Name): GAFFAR ENTERPRISES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 3RD AVE
OAKLAND CA
94606-1853
US

IV. Provider business mailing address

1901 3RD AVE
OAKLAND CA
94606-1853
US

V. Phone/Fax

Practice location:
  • Phone: 510-834-9880
  • Fax: 510-763-7367
Mailing address:
  • Phone: 510-834-9880
  • Fax: 510-763-7367

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberZZR05543I
License Number StateCA

VIII. Authorized Official

Name: MR. GAFFAR SYED
Title or Position: ADMINSTRATOR
Credential: ADOMINSTRATOR
Phone: 510-834-9880