Healthcare Provider Details

I. General information

NPI: 1598630105
Provider Name (Legal Business Name): ALICIA MAREIE PRATT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/06/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

37 8TH AVE UNIT 520
OAKLAND CA
94606-5348
US

IV. Provider business mailing address

37 8TH AVE UNIT 520
OAKLAND CA
94606-5348
US

V. Phone/Fax

Practice location:
  • Phone: 254-833-3770
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68314
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: