Provider Demographics
NPI:1376646489
Name:RISHON, ANNE DEBORAH (NPF)
Entity Type:Individual
Prefix:
First Name:ANNE
Middle Name:DEBORAH
Last Name:RISHON
Suffix:
Gender:F
Credentials:NPF
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:747 52ND ST
Mailing Address - Street 2:
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 1:2500 FAIRMONT DR
Practice Address - Street 2:
Practice Address - City:SAN LEANDRO
Practice Address - State:CA
Practice Address - Zip Code:94578-1005
Practice Address - Country:US
Practice Address - Phone:510-667-4931
Practice Address - Fax:510-483-2369
Is Sole Proprietor?:No
Enumeration Date:2006-09-06
Last Update Date:2013-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CANPF8608363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFHC71021FMedicaid
CAHAP71021FOtherFPACT
CAZZZ29799ZOtherFQHC MEDICARE PART B
CA55-1975OtherFQHC MEDICARE PART A