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General NPI Number Information
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NPI Number | 1336599570
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Entity Type | Organization
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Legal Business Name | MEMORY DAYBYDAY
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Dates
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Enumeration Date | 06/19/2016
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Last Update Date | 09/16/2016
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Provider Practice Location Address
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Address Line | 111 JACKSON ST
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City | HAYWARD
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State | CA
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Zip | 94544-1948
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Country | US
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Telephone | 510-876-5880
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Fax | 510-876-5885
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Provider Business Mailing Address
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Address Line | 111 JACKSON ST
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City | HAYWARD
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State | CA
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Zip | 94544-1948
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Country | US
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Telephone | 510-876-5880
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Fax | 510-876-5885
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Authorized Official
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Title or Position | PRESIDENT
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Name | PATRICIA BRUKETTA
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Credential | NP
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Telephone | 510-876-5880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 408641
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 252Y00000X
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Taxonomy Name | Early Intervention Provider Agency
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License Number | 408641
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License Number State | CA
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