Provider Demographics
NPI:1922548601
Name:NORTHERN CALIFORNIA OCCUPATIONAL CLINIC INC
Entity Type:Organization
Organization Name:NORTHERN CALIFORNIA OCCUPATIONAL CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HESSAM
Authorized Official - Middle Name:
Authorized Official - Last Name:NORALAHI
Authorized Official - Suffix:
Authorized Official - Credentials:MD, QME
Authorized Official - Phone:510-532-5242
Mailing Address - Street 1:2648 INTERNATIONAL BLVD
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-1547
Mailing Address - Country:US
Mailing Address - Phone:510-532-5242
Mailing Address - Fax:510-533-7918
Practice Address - Street 1:2648 INTERNATIONAL BLVD
Practice Address - Street 2:SUITE 302
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601-1547
Practice Address - Country:US
Practice Address - Phone:510-532-5242
Practice Address - Fax:510-533-7918
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-01
Last Update Date:2017-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79160208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty