=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225220445
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KERRILYNN SOLDAVINI-AMAYO LVN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/12/2007
-----------------------------------------------------
Last Update Date | 08/12/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1124 INTERNATIONAL BLVD
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94606-4331
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-533-0800
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 720031
-----------------------------------------------------
City | SAN FRANCISCO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94172-0031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-414-5511
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | VN159261
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------