| Proto | |
|
400 30th St Ste 407 Oakland CA 94609-3306 | |
| (415) 735-6453 | |
| (415) 548-2181 |
| Full Name | Proto |
|---|---|
| Speciality | Psychiatry & Neurology |
| Location | 400 30th St Ste 407, Oakland, California |
| Authorized Official Name and Position | Michael C Hoaglin (OWNER) |
| Authorized Official Contact | 4157356453 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Proto 400 30th St Ste 407 Oakland CA 94609-3306 Ph: (415) 735-6453 | Proto 400 30th St Ste 407 Oakland CA 94609-3306 Ph: (415) 735-6453 |
| NPI Number | 1558954545 |
|---|---|
| Provider Enumeration Date | 02/19/2021 |
| Last Update Date | 07/30/2023 |
| Certification Date | 07/30/2023 |
| Medicare PECOS PAC ID | 8921405291 |
|---|---|
| Medicare Enrollment ID | O20220531002103 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1558954545 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 2084P0015X | Psychiatry & Neurology - Psychosomatic Medicine | (* (Not Available)) | Primary |
| 261Q00000X | Clinic/center | (* (Not Available)) | Secondary |
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