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NPI Code Detail

MEDICARE: AGNES WARHOVER PA

MEDICARE: AGNES WARHOVER PA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA18641CA

General Provider Information

NPI Number : 1346432929
Entity Type Code : Individual
Provider Name (Legal Business Name) : AGNES WARHOVER PA
Provider Business Mailing Address
First Line : 1335 STANFORD AVE
Second Line :
City : EMERYVILLE
State : CA
Zip : 94608-2536
Country : US
Telephone Number : 510-647-5101
Fax Number : 510-647-5105
Provider Business Practice Location Address
First Line : 1335 STANFORD AVE
Second Line :
City : EMERYVILLE
State : CA
Zip : 94608-2536
Country : US
Telephone Number : 510-647-5101
Fax Number : 510-647-5105
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/16/2007
Last Update Date : 12/04/2023

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