MEDICARE: MR. ARI OKLAN

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
1	103TF0000X	Family Psychologist	PSY30350	CA
2	103TC0700X	Clinical Psychologist	PSY30350	CA

General Provider Information

NPI Number	:	1962759449
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. ARI OKLAN

Provider Business Mailing Address
First Line	:	3075 ADELINE ST STE 120
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-2579
Country	:	US
Telephone Number	:	510-848-1112
Fax Number	:	510-848-4445

Provider Business Practice Location Address
First Line	:	3075 ADELINE ST STE 120
Second Line	:
City	:	BERKELEY
State	:	CA
Zip	:	94703-2579
Country	:	US
Telephone Number	:	510-848-1112
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/14/2012
Last Update Date	:	03/30/2021

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Directions to “ MR. ARI OKLAN ” Practice Location

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