Healthcare Provider Details

I. General information

NPI: 1922404250
Provider Name (Legal Business Name): SHERYL LLARENA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2014
Last Update Date: 01/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

545 ESTUDILLO AVE
SAN LEANDRO CA
94577-4611
US

IV. Provider business mailing address

545 ESTUDILLO AVE
SAN LEANDRO CA
94577-4611
US

V. Phone/Fax

Practice location:
  • Phone: 510-352-9200
  • Fax:
Mailing address:
  • Phone: 510-352-9200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License NumberIMF78540
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: