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NPI Code Detail

MEDICARE: TONYA DIANE PETTY

MEDICARE: TONYA DIANE PETTY
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
1103TS0200XSchool Psychologist140206821CA
2101Y00000XCounselor

General Provider Information

NPI Number : 1972775765
Entity Type Code : Individual
Provider Name (Legal Business Name) : TONYA DIANE PETTY
Provider Business Mailing Address
First Line : 1011 UNION ST
Second Line :
City : OAKLAND
State : CA
Zip : 94607-2236
Country : US
Telephone Number : 510-879-8000
Fax Number :
Provider Business Practice Location Address
First Line : 1011 UNION ST
Second Line :
City : OAKLAND
State : CA
Zip : 94607-2236
Country : US
Telephone Number : 510-879-5003
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/01/2008
Last Update Date : 08/21/2024

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Directions to “ TONYA DIANE PETTY ” Practice Location

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