Provider Demographics
NPI:1154661205
Name:PUBLIC HEALTH NURSING DEPARTMENT
Entity Type:Organization
Organization Name:PUBLIC HEALTH NURSING DEPARTMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHN MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:MARILYN
Authorized Official - Middle Name:MALALANG
Authorized Official - Last Name:ROMERO
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:510-830-9123
Mailing Address - Street 1:1628 MAGNOLIA LN
Mailing Address - Street 2:
Mailing Address - City:SAN LEANDRO
Mailing Address - State:CA
Mailing Address - Zip Code:94577-2642
Mailing Address - Country:US
Mailing Address - Phone:510-830-9123
Mailing Address - Fax:
Practice Address - Street 1:7200 BANCROFT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2403
Practice Address - Country:US
Practice Address - Phone:510-577-7037
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-27
Last Update Date:2013-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251K00000XAgenciesPublic Health or Welfare