Provider Demographics
NPI:1285696062
Name:NORTH OAKLAND MEDICAL CLINIC A PROFESSIONAL CORP
Entity type:Organization
Organization Name:NORTH OAKLAND MEDICAL CLINIC A PROFESSIONAL CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANITA
Authorized Official - Middle Name:L
Authorized Official - Last Name:THOMPSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-658-7660
Mailing Address - Street 1:6105 SAN PABLO AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2225
Mailing Address - Country:US
Mailing Address - Phone:510-658-7660
Mailing Address - Fax:510-658-5138
Practice Address - Street 1:6105 SAN PABLO AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94608-2225
Practice Address - Country:US
Practice Address - Phone:510-658-7660
Practice Address - Fax:510-658-5138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-05
Last Update Date:2010-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00C312110Medicaid
CA00C312110Medicare PIN
CAA34486Medicare UPIN