Provider Demographics
NPI:1508134248
Name:OBA, HISAKO (CMT)
Entity Type:Individual
Prefix:
First Name:HISAKO
Middle Name:
Last Name:OBA
Suffix:
Gender:F
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1159 HEARST AVE APT A
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94702-1621
Mailing Address - Country:US
Mailing Address - Phone:510-644-1530
Mailing Address - Fax:510-644-1530
Practice Address - Street 1:2718 TELEGRAPH AVE STE 103
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94705-1142
Practice Address - Country:US
Practice Address - Phone:510-295-9820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2011-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12104225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist