Basic Information
| Provider Information | |||||||||
| NPI: | 1972671725 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AU | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | G | ||||||||
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| OtherLastName: | AU | ||||||||
| OtherFirstName: | VAN | ||||||||
| OtherMiddleName: | GIA | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 350 30TH ST | ||||||||
| Address2: | #320 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946093424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104656700 | ||||||||
| FaxNumber: | 5104657765 | ||||||||
| Practice Location | |||||||||
| Address1: | 350 30TH ST | ||||||||
| Address2: | #320 | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946093424 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104656700 | ||||||||
| FaxNumber: | 5104657765 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/01/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2471B0102X | RHP88756 | CA | Y | Technologists, Technicians & Other Technical Service Providers | Radiologic Technologist | Bone Densitometry |
No ID Information.