Basic Information
| Provider Information | |||||||||
| NPI: | 1619275930 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCCARRON | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | DECLAN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 535 PIERCE ST. | ||||||||
| Address2: | #3300 | ||||||||
| City: | ALBANY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 947061058 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5103568468 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4368 LINCOLN AVENUE | ||||||||
| Address2: | LINCOLN CHILD CENTER | ||||||||
| City: | OAKLAND | ||||||||
| State: | CA | ||||||||
| PostalCode: | 946022529 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5105313111 | ||||||||
| FaxNumber: | 5105308083 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2011 | ||||||||
| LastUpdateDate: | 03/10/2011 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.