Healthcare Provider Details

I. General information

NPI: 1467188516
Provider Name (Legal Business Name): MATHEW SOMMERS NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/29/2022
Last Update Date: 11/02/2022
Certification Date: 11/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3100 SUMMIT ST FL 2
OAKLAND CA
94609-3412
US

IV. Provider business mailing address

3100 SUMMIT ST FL 2
OAKLAND CA
94609-3412
US

V. Phone/Fax

Practice location:
  • Phone: 510-869-8400
  • Fax:
Mailing address:
  • Phone: 510-869-8400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number95021943
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: