Provider Demographics
NPI:1063428084
Name:EARLY, LORETTA F (MD)
Entity type:Individual
Prefix:DR
First Name:LORETTA
Middle Name:F
Last Name:EARLY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4100 35TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94619-1504
Mailing Address - Country:US
Mailing Address - Phone:510-530-6790
Mailing Address - Fax:510-530-6791
Practice Address - Street 1:4100 35TH AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94619-1504
Practice Address - Country:US
Practice Address - Phone:510-530-6790
Practice Address - Fax:510-530-6791
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG11370208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G113700Medicaid
CAA38332Medicare UPIN