Healthcare Provider Details

I. General information

NPI: 1891848990
Provider Name (Legal Business Name): VANINA GUNARTO FNP-BC, RN, PHN, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 01/03/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST HIGHLAND GENERAL HOSPITAL - ADULT MEDICINE CLINIC K6A
OAKLAND CA
94602-1018
US

IV. Provider business mailing address

1411 E 31ST ST HIGHLAND GENERAL HOSPITAL - ADULT MEDICINE CLINIC K6A
OAKLAND CA
94602-1018
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-5039
  • Fax: 510-535-7313
Mailing address:
  • Phone: 510-437-5039
  • Fax: 510-535-7313

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN#613509 NP#14787
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: