| Prana Mind Center | |
|
459 W Macarthur Blvd Oakland CA 94609-2808 | |
| (877) 459-6463 | |
| (877) 459-6463 |
| Full Name | Prana Mind Center |
|---|---|
| Speciality | Clinical Neuropsychologist |
| Location | 459 W Macarthur Blvd, Oakland, California |
| Authorized Official Name and Position | Paul Jackson (CLINICAL DIRECTOR) |
| Authorized Official Contact | 8774596463 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Prana Mind Center 459 W Macarthur Blvd Oakland CA 94609-2808 Ph: (877) 459-6463 | Prana Mind Center 459 W Macarthur Blvd Oakland CA 94609-2808 Ph: (877) 459-6463 |
| NPI Number | 1558994277 |
|---|---|
| Provider Enumeration Date | 02/21/2020 |
| Last Update Date | 10/27/2020 |
| Certification Date | 10/27/2020 |
| Medicare PECOS PAC ID | 3971913294 |
|---|---|
| Medicare Enrollment ID | O20201027002928 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558994277 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 103G00000X | Clinical Neuropsychologist | (* (Not Available)) | Primary |
| Provider Name | Paul A Jackson |
|---|---|
| Provider Type | Practitioner - Clinical Psychologist |
| Provider Identifiers | NPI Number: 1477112522 PECOS PAC ID: 3678983996 Enrollment ID: I20201030001106 |
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