Facts
- Status
- A
- Type
- Individual
- Enumeration date
- 2023-03-27
- Last updated
- 2025-11-27
Licenses
- License CA
- Number not in the file
- License CA
- 35202
Location
- Practice location
- 3124 INTERNATIONAL BLVD
- City
- OAKLAND CA
- Postal code
- 946012902
- Phone
- 510-535-4400
Medicare
- PECOS
- A PECOS enrollment row matches this NPI.
LEIE
The OIG NPI list is not in this build yet. Confirm on OIG's search.
Nearby
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Removal request
Public data from NPPES and CMS. Not a credentialing determination.