Healthcare Provider Details

I. General information

NPI: 1376899310
Provider Name (Legal Business Name): DEVORAH COHEN ROISMAN C.N.M., W.H.N.P
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBRA GIPSMAN ROISMAN C.N.M, W.H.N.P.

II. Dates (important events)

Enumeration Date: 07/27/2012
Last Update Date: 11/17/2022
Certification Date: 11/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 E 31ST ST
OAKLAND CA
94602-1018
US

IV. Provider business mailing address

1411 E 31ST ST
OAKLAND CA
94602-1018
US

V. Phone/Fax

Practice location:
  • Phone: 510-437-4800
  • Fax:
Mailing address:
  • Phone: 510-437-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License Number22157
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number2007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: