1285696062 NPI number — NORTH OAKLAND MEDICAL CLINIC A PROFESSIONAL CORP

Table of content: (NPI 1285696062)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1285696062 NPI number — NORTH OAKLAND MEDICAL CLINIC A PROFESSIONAL CORP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
NORTH OAKLAND MEDICAL CLINIC A PROFESSIONAL CORP
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1285696062
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/10/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6105 SAN PABLO AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OAKLAND
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94608-2225
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-658-7660
Provider Business Mailing Address Fax Number:
510-658-5138

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6105 SAN PABLO AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94608-2225
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-658-7660
Provider Business Practice Location Address Fax Number:
510-658-5138
Provider Enumeration Date:
04/05/2006

Additional Information

Authorized Official

Authorized Official Last Name:
THOMPSON
Authorized Official First Name:
ANITA
Authorized Official Middle Name:
L
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
510-658-7660

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00C312110 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".




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