1801963996 NPI number — DR. ERVIN EPSTEIN JR. M.D.

Table of content: REBEKKA STEPHENS (NPI 1467261883)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801963996 NPI number — DR. ERVIN EPSTEIN JR. M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EPSTEIN
Provider First Name:
ERVIN
Provider Middle Name:
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
JR.
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1801963996
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
400 - 30TH STREET
Provider Second Line Business Mailing Address:
SUITE 205
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94609-3305
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-444-8282
Provider Business Mailing Address Fax Number:
510-444-8284

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
400 30TH ST
Provider Second Line Business Practice Location Address:
SUITE 205
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609-3306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-444-8282
Provider Business Practice Location Address Fax Number:
510-444-8284
Provider Enumeration Date:
11/30/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207N00000X , with the licence number:  A22751 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 00A227510 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7158129 . This is a "CCS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 030854 . This is a "HILL PHYSICIANS" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 00A227510 . This is a "BLUE SHILED" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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