Provider Demographics
NPI:1710420575
Name:REDZIC, ELVEDINA
Entity Type:Individual
Prefix:
First Name:ELVEDINA
Middle Name:
Last Name:REDZIC
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94610-5022
Mailing Address - Country:US
Mailing Address - Phone:510-474-0690
Mailing Address - Fax:510-280-5620
Practice Address - Street 1:2740 GRANT ST
Practice Address - Street 2:
Practice Address - City:CONCORD
Practice Address - State:CA
Practice Address - Zip Code:94520-2265
Practice Address - Country:US
Practice Address - Phone:925-674-2360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-28
Last Update Date:2018-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95005163363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily