Healthcare Provider Details

I. General information

NPI: 1831069590
Provider Name (Legal Business Name): NAVIN BANSAL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/07/2025
Last Update Date: 11/07/2025
Certification Date: 11/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 LEONARD DR
SAN LEANDRO CA
94577-2459
US

IV. Provider business mailing address

1700 LEONARD DR
SAN LEANDRO CA
94577-2459
US

V. Phone/Fax

Practice location:
  • Phone: 510-618-4450
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YS0200X
TaxonomySchool Counselor
License Number240167687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: