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General NPI Number Information
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NPI Number | 1336693654
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Entity Type | Organization
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Legal Business Name | ON CALL PROVIDER SERVICE
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Dates
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Enumeration Date | 08/04/2016
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Last Update Date | 08/04/2016
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Provider Practice Location Address
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Address Line | 2321 86TH AVE
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City | OAKLAND
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State | CA
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Zip | 94605-3907
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Country | US
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Telephone | 510-325-1734
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Fax | 510-562-6493
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Provider Business Mailing Address
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Address Line | 2321 86TH AVE
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City | OAKLAND
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State | CA
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Zip | 94605-3907
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Country | US
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Telephone | 510-325-1734
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Fax | 510-562-6493
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Authorized Official
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Title or Position | CEO
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Name | MS. SHARONNE ELAINE ROGERS
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Credential | FNP
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Telephone | 510-325-1734
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | 14579
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License Number State | CA
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