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NPI Code Detail

MEDICARE: JESUS EL

MEDICARE: JESUS EL
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
1172V00000XCommunity Health Worker

General Provider Information

NPI Number : 1588432991
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESUS EL
Provider Business Mailing Address
First Line : 3425 WILSON AVE APT 3
Second Line :
City : OAKLAND
State : CA
Zip : 94602-2957
Country : US
Telephone Number : 510-368-9024
Fax Number :
Provider Business Practice Location Address
First Line : 2828 FORD ST
Second Line :
City : OAKLAND
State : CA
Zip : 94601-2114
Country : US
Telephone Number : 510-844-6715
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/14/2023
Last Update Date : 01/19/2024

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Directions to “ JESUS EL ” Practice Location

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