Healthcare Provider Details

I. General information

NPI: 1164988739
Provider Name (Legal Business Name): DEMETRIUS LEE HOPKINS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2019
Last Update Date: 02/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

901 NEVIN AVE
RICHMOND CA
94801-3143
US

IV. Provider business mailing address

5308 BIRDIE CT
RICHMOND CA
94806-5205
US

V. Phone/Fax

Practice location:
  • Phone: 510-307-1730
  • Fax:
Mailing address:
  • Phone: 510-507-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code227800000X
TaxonomyCertified Respiratory Therapist
License NumberRCP16052
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: