Provider Demographics
NPI:1225344500
Name:CORRIVEAU, JACQUES-EMMANUEL BERNARD (MD)
Entity Type:Individual
Prefix:DR
First Name:JACQUES-EMMANUEL
Middle Name:BERNARD
Last Name:CORRIVEAU
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:JACQUES
Other - Middle Name:
Other - Last Name:CORRIVEAU
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:747 52ND ST
Mailing Address - Street 2:MEDICAL EDUCATION - OAKLAND CHILDREN'S HOSPITAL
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1809
Mailing Address - Country:US
Mailing Address - Phone:510-428-3000
Mailing Address - Fax:
Practice Address - Street 1:747 52ND ST
Practice Address - Street 2:MEDICAL EDUCATION - OAKLAND CHILDREN'S HOSPITAL
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1809
Practice Address - Country:US
Practice Address - Phone:510-428-3000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA111455208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics