=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962540674
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CATHOLIC CHARITIES OF THE DIOCESE OF OAKLAND
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/02/2007
-----------------------------------------------------
Last Update Date | 10/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 433 JEFFERSON ST
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94607-3539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-768-3100
-----------------------------------------------------
Fax | 510-451-6998
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 433 JEFFERSON ST
-----------------------------------------------------
City | OAKLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 94607-3539
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 510-768-3100
-----------------------------------------------------
Fax | 510-451-6998
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF PROGRAM OFFICER
-----------------------------------------------------
Name | CHRISTOPHER NERY MARTINEZ
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 510-823-7517
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------