Basic Information
| Provider Information | |||||||||
| NPI: | 1982994869 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDRENS HOSPITAL & RESEARCH CENTER AT OAKLAND | ||||||||
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| Mailing Information | |||||||||
| Address1: | 747 52ND STREET | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946091809 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104283885 | ||||||||
| FaxNumber: | 5104283840 | ||||||||
| Practice Location | |||||||||
| Address1: | 2607 MYRTLE ST | ||||||||
| Address2: | |||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946073415 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104283885 | ||||||||
| FaxNumber: | 5104283840 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/13/2011 | ||||||||
| LastUpdateDate: | 03/30/2018 | ||||||||
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| AuthorizedOfficialLastName: | REID | ||||||||
| AuthorizedOfficialFirstName: | COLLEEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CONTROLLER | ||||||||
| AuthorizedOfficialTelephone: | 5104283467 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CHILDREN'S HOSPITAL & RESEARCH CENTER AT | ||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | CPA | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QS1000X | 140000015 | CA | Y | Ambulatory Health Care Facilities | Clinic/Center | Student Health |
No ID Information.