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General NPI Number Information
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NPI Number | 1841972635
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Entity Type | Organization
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Legal Business Name | DREAM YOUTH CLINIC
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Dates
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Enumeration Date | 08/02/2023
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Last Update Date | 08/02/2023
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Provider Practice Location Address
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Address Line | 583 5TH ST STE A
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City | OAKLAND
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State | CA
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Zip | 94607-3500
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Country | US
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Telephone | 510-457-8767
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Fax |
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Provider Business Mailing Address
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Address Line | 583 5TH ST STE A
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City | OAKLAND
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State | CA
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Zip | 94607-3500
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Country | US
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Telephone | 510-457-8767
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Fax |
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Authorized Official
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Title or Position | CHIEF OPERATING OFFICER
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Name | DR. AISHA R MAYS
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Credential | MD
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Telephone | 510-457-8767
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207QA0000X
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Taxonomy Name | Adolescent Medicine (Family Medicine) Physician
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License Number |
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License Number State |
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