Healthcare Provider Details

I. General information

NPI: 1851796718
Provider Name (Legal Business Name): NEIL NEDER CPT
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2014
Last Update Date: 11/04/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 MARINA WAY S STE 2
RICHMOND CA
94804-3745
US

IV. Provider business mailing address

801 MARINA WAY S STE 2
RICHMOND CA
94804-3745
US

V. Phone/Fax

Practice location:
  • Phone: 510-868-6030
  • Fax: 510-868-0844
Mailing address:
  • Phone: 510-868-6030
  • Fax: 510-868-0844

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246RP1900X
TaxonomyPhlebotomy Technician
License NumberCPT00053443
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: