Provider Demographics
NPI:1497200778
Name:LABYA, HOM DE SAN
Entity Type:Individual
Prefix:
First Name:HOM
Middle Name:DE SAN
Last Name:LABYA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:268 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-4724
Mailing Address - Country:US
Mailing Address - Phone:415-990-5902
Mailing Address - Fax:
Practice Address - Street 1:268 GRAND AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94610-4724
Practice Address - Country:US
Practice Address - Phone:415-990-5902
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-17
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker