Provider Demographics
NPI:1528400553
Name:POWELL, XAVIER ALEXANDER (CMT)
Entity Type:Individual
Prefix:MR
First Name:XAVIER
Middle Name:ALEXANDER
Last Name:POWELL
Suffix:
Gender:M
Credentials:CMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:292 4TH ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4332
Mailing Address - Country:US
Mailing Address - Phone:877-658-4757
Mailing Address - Fax:
Practice Address - Street 1:915 29TH ST
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94804-1303
Practice Address - Country:US
Practice Address - Phone:510-375-4686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-18
Last Update Date:2013-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist
No174H00000XOther Service ProvidersHealth Educator