Provider Demographics
NPI:1619275930
Name:MCCARRON, MICHAEL DECLAN
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:DECLAN
Last Name:MCCARRON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:535 PIERCE ST.
Mailing Address - Street 2:#3300
Mailing Address - City:ALBANY
Mailing Address - State:CA
Mailing Address - Zip Code:94706-1058
Mailing Address - Country:US
Mailing Address - Phone:510-356-8468
Mailing Address - Fax:
Practice Address - Street 1:4368 LINCOLN AVENUE
Practice Address - Street 2:LINCOLN CHILD CENTER
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94602-2529
Practice Address - Country:US
Practice Address - Phone:510-531-3111
Practice Address - Fax:510-530-8083
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program