IMHOTEP ISSAQUENA MEDICAL GROUP NPI 1659405165

NPI Information

IMHOTEP ISSAQUENA MEDICAL GROUP is a primary care clinic center in Oakland, CA. IMHOTEP ISSAQUENA MEDICAL GROUP NPI is 1659405165. The provider is registered as an organization entity type.

The provider's business location address is:

401 29TH ST
#206
OAKLAND, CA
ZIP 94609-519
Phone: (510) 231-0955
Fax: (510) 231-0482

The provider's authorized official is Otis Eugene Rounds .
The authorized official title is President and has the following contact phone number (510) 231-0955.

The enumeration date for this NPI number is 3/15/2007 and was last updated on 6/27/2008.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

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