Healthcare Provider Details

I. General information

NPI: 1952836769
Provider Name (Legal Business Name): JAMOSE TERREFORTE NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2017
Last Update Date: 10/14/2022
Certification Date: 10/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1144 65TH ST STE F
OAKLAND CA
94608-1053
US

IV. Provider business mailing address

1144 65TH ST STE F
OAKLAND CA
94608-1053
US

V. Phone/Fax

Practice location:
  • Phone: 510-929-1400
  • Fax: 510-929-1414
Mailing address:
  • Phone: 510-929-1400
  • Fax: 510-929-1414

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024174744
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95021972
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: