Provider Demographics
NPI:1710404751
Name:HAXO, AILEEN FLORENCE (RN)
Entity Type:Individual
Prefix:
First Name:AILEEN
Middle Name:FLORENCE
Last Name:HAXO
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 BROADWAY STE 500
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4033
Mailing Address - Country:US
Mailing Address - Phone:510-208-5930
Mailing Address - Fax:510-267-3212
Practice Address - Street 1:7200 BANCROFT AVE STE 202
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94605-2471
Practice Address - Country:US
Practice Address - Phone:510-577-7080
Practice Address - Fax:510-577-7078
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2017-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA764721163W00000X, 163WC0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC0400XNursing Service ProvidersRegistered NurseCase Management
No163W00000XNursing Service ProvidersRegistered Nurse