Provider Demographics
NPI:1083954531
Name:PREP
Entity Type:Organization
Organization Name:PREP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARE ADVOCATE INTERN
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:RENEE
Authorized Official - Last Name:LEAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-409-9231
Mailing Address - Street 1:1814 FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3487
Mailing Address - Country:US
Mailing Address - Phone:510-318-6100
Mailing Address - Fax:
Practice Address - Street 1:1814 FRANKLIN ST
Practice Address - Street 2:400
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94612-3487
Practice Address - Country:US
Practice Address - Phone:510-318-6100
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-20
Last Update Date:2013-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty