Provider Demographics
NPI:1699210153
Name:SWAYNE, ASHMOND
Entity Type:Individual
Prefix:
First Name:ASHMOND
Middle Name:
Last Name:SWAYNE
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 1:6405 BRANN ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94605-2046
Mailing Address - Country:US
Mailing Address - Phone:510-672-8545
Mailing Address - Fax:
Practice Address - Street 1:6405 BRANN ST APT B
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2046
Practice Address - Country:US
Practice Address - Phone:510-672-8545
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-19
Last Update Date:2016-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management