Basic Information
| Provider Information | |||||||||
| NPI: | 1144429754 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CHILDREN'S HOSPITAL AND RESEARCH CENTER-OAKLAND | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5275 CLAREMONT AVE | ||||||||
| Address2: | CENTER FOR THE VULNERABLE CHILD | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946181032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104283885 | ||||||||
| FaxNumber: | 5106013913 | ||||||||
| Practice Location | |||||||||
| Address1: | 5275 CLAREMONT AVE | ||||||||
| Address2: | CENTER FOR THE VULNERABLE CHILD | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946181032 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104283885 | ||||||||
| FaxNumber: | 5106013913 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2007 | ||||||||
| LastUpdateDate: | 07/13/2007 | ||||||||
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| AuthorizedOfficialLastName: | MILLER | ||||||||
| AuthorizedOfficialFirstName: | JILL | ||||||||
| AuthorizedOfficialMiddleName: | DAESHAUN | ||||||||
| AuthorizedOfficialTitleorPosition: | MENTAL HEALTH WORKER II | ||||||||
| AuthorizedOfficialTelephone: | 5104283885 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PSY.D | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 282NC2000X | Y | Hospitals | General Acute Care Hospital | Children |
No ID Information.