Healthcare Provider Details

I. General information

NPI: 1982201646
Provider Name (Legal Business Name): SETH DAVID GOLUB
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2020
Last Update Date: 09/18/2024
Certification Date: 09/18/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

445 BELLEVUE AVE STE 202
OAKLAND CA
94610-4923
US

IV. Provider business mailing address

6645 HEARTWOOD DR
OAKLAND CA
94611-2334
US

V. Phone/Fax

Practice location:
  • Phone: 415-672-4081
  • Fax:
Mailing address:
  • Phone: 415-672-4081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number110019
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number138667
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: