=====================================================
General NPI Number Information
=====================================================
NPI Number | 1053340133
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FOUNDATION FOR OSTEOPOROSIS RESEARCH & EDUCATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/01/2006
-----------------------------------------------------
Last Update Date | 07/19/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1814 FRANKLIN ST SUITE 620
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94612-3426
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-832-2663
-----------------------------------------------------
Fax | 510-208-7174
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1814 FRANKLIN STREET SUITE 620
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94612-3438
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-832-2663
-----------------------------------------------------
Fax | 510-208-7174
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | KATHLEEN CODY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-832-2663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2085R0202X
-----------------------------------------------------
Taxonomy Name | Diagnostic Radiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------