Healthcare Provider Details

I. General information

NPI: 1306138375
Provider Name (Legal Business Name): REBECCA MANNING HADJES CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: REBECCA MANNING TSENG

II. Dates (important events)

Enumeration Date: 05/10/2011
Last Update Date: 12/20/2022
Certification Date: 12/20/2022
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: 510-437-4969
  • Fax:
Mailing address:
  • Phone: 510-437-4969
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4172
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: