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General NPI Number Information
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NPI Number | 1205167491
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Entity Type | Organization
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Legal Business Name | ENVISION ACADEMY
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Dates
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Enumeration Date | 01/27/2010
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Last Update Date | 10/04/2012
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Provider Practice Location Address
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Address Line | 1515 WEBSTER STREET
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City | OAKLAND
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State | CA
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Zip | 94612-3355
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Country | US
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Telephone | 510-596-8901
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Fax | 510-596-8905
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Provider Business Mailing Address
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Address Line | 111 MYRTLE ST SUITE 203
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City | OAKLAND
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State | CA
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Zip | 94607-2525
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Country | US
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Telephone | 510-451-2415
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Fax | 510-451-2768
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Authorized Official
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Title or Position | SUPERINTENDENT
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Name | MS. GIA TRUONG
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Credential |
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Telephone | 510-451-2415
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251300000X
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Taxonomy Name | Local Education Agency (LEA)
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License Number |
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License Number State |
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