Basic Information
Provider Information
NPI: 1558808741
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: PAREDES
FirstName: KARINA
MiddleName: GABRIELA
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2330 BLAKE ST
Address2: APT 1
City: BERKELEY
State: CA
PostalCode: 947042874
CountryCode: US
TelephoneNumber: 8057098071
FaxNumber:  
Practice Location
Address1: 7200 BANCROFT AVE
Address2: STE 267
City: OAKLAND
State: CA
PostalCode: 946052403
CountryCode: US
TelephoneNumber: 5107350864
FaxNumber:  
Other Information
ProviderEnumerationDate: 01/25/2017
LastUpdateDate: 01/25/2017
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
174400000X CAY Other Service ProvidersSpecialist 

No ID Information.


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