Healthcare Provider Details

I. General information

NPI: 1285195537
Provider Name (Legal Business Name): DIVERSITY IN HEALTH TRAINING INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2019
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 CALLAN AVE STE 220
SAN LEANDRO CA
94577-4558
US

IV. Provider business mailing address

101 CALLAN AVE STE 220
SAN LEANDRO CA
94577-4558
US

V. Phone/Fax

Practice location:
  • Phone: 510-838-1110
  • Fax:
Mailing address:
  • Phone: 510-838-1110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: HAJIRA WALIZADA
Title or Position: PROGRAM MANAGER
Credential:
Phone: 925-354-1249