Healthcare Provider Details

I. General information

NPI: 1376471912
Provider Name (Legal Business Name): WHIPPEDBYNISEY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 SAN PABLO AVE
OAKLAND CA
94612-1507
US

IV. Provider business mailing address

PO BOX 1305
SUISUN CITY CA
94585-4305
US

V. Phone/Fax

Practice location:
  • Phone: 510-479-0765
  • Fax:
Mailing address:
  • Phone: 510-479-0765
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code335E00000X
TaxonomyProsthetic/Orthotic Supplier
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: ARMANISE CARR
Title or Position: OWNER
Credential:
Phone: 510-479-0765