1326182957 NPI number — DR. SUSAN COLE SYKES MD

Table of content: TESS SHATTO (NPI 1568170918)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326182957 NPI number — DR. SUSAN COLE SYKES MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SYKES
Provider First Name:
SUSAN
Provider Middle Name:
COLE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
F

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:
1326182957
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/13/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1601 FRUITVALE 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:
94601-2322
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
510-535-4000
Provider Business Mailing Address Fax Number:
510-535-4128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3451 E 12TH STREET
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:
94601
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
510-535-3317
Provider Business Practice Location Address Fax Number:
510-535-4248
Provider Enumeration Date:
02/16/2007

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: 207V00000X , with the licence number:  G61073 , 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: ZZZ29799Z . This is a "MEDICARE PART B" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: FHC71021F , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: HAP71021F . This is a "FPACT" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".
  • Identifier: 55-1975 . This is a "MEDICARE PART A" identifier , issued by the state of ( CA ) . This identifiers is of the category "OTHER".




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