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General NPI Number Information
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NPI Number | 1043628910
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Entity Type | Individual
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Provider Name | CAROL HABERCOSS
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Gender | Female
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Dates
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Enumeration Date | 07/23/2014
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Last Update Date | 07/23/2014
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Provider Practice Location Address
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Address Line | 6955 FOOTHILL BLVD STE 188
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City | OAKLAND
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State | CA
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Zip | 94605-2455
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Country | US
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Telephone | 510-388-1768
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Fax |
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Provider Business Mailing Address
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Address Line | 14360 HEMLOCK ST
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City | SAN LEANDRO
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State | CA
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Zip | 94579-1134
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 132700000X
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Taxonomy Name | Dietary Manager
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License Number |
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License Number State | CA
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