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General NPI Number Information
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NPI Number | 1962015701
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Entity Type | Individual
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Provider Name | EGBEBALAKHAMEN IYABO OMOREGIE NP
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Gender | Female
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Dates
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Enumeration Date | 08/30/2020
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Last Update Date | 02/06/2026
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Provider Practice Location Address
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Address Line | 1411 E 31ST ST
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City | OAKLAND
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State | CA
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Zip | 94602-1018
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Country | US
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Telephone | 510-535-7382
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Fax |
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Provider Business Mailing Address
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Address Line | 300 PASTEUR DR
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City | STANFORD
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State | CA
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Zip | 94305-2200
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Country | US
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Telephone | 650-723-4000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | NP95013296
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License Number State | CA
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