Healthcare Provider Details

I. General information

NPI: 1902711500
Provider Name (Legal Business Name): MICHEL MUANZA LAU FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/18/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3508 LYON AVE
OAKLAND CA
94601-3840
US

IV. Provider business mailing address

3508 LYON AVE
OAKLAND CA
94601-3840
US

V. Phone/Fax

Practice location:
  • Phone: 510-220-7584
  • Fax:
Mailing address:
  • Phone: 510-220-7584
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95041089
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: