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General NPI Number Information
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NPI Number | 1194403048
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Entity Type | Individual
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Provider Name | DAVID WILLIAM MODERSBACH
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Gender | Male
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Dates
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Enumeration Date | 07/10/2023
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Last Update Date | 01/03/2024
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Provider Practice Location Address
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Address Line | 1404 FRANKLIN ST STE 200
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City | OAKLAND
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State | CA
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Zip | 94612-3208
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Country | US
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Telephone | 510-891-8916
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Fax | 510-273-3802
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Provider Business Mailing Address
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Address Line | 2265 COURTLAND AVE
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City | OAKLAND
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State | CA
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Zip | 94601-4707
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Country | US
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Telephone | 510-535-9122
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | 04011994
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License Number State | CA
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