Provider Demographics
NPI:1134229388
Name:WEBSTER-LONGIN, MARIA LUZ (MD)
Entity type:Individual
Prefix:
First Name:MARIA
Middle Name:LUZ
Last Name:WEBSTER-LONGIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:LUZ
Other - Last Name:WEBSTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:1601 FRUITVALE AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94601-2322
Mailing Address - Country:US
Mailing Address - Phone:510-535-4000
Mailing Address - Fax:510-535-4128
Practice Address - Street 1:1030 INTERNATIONAL BLVD
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94601
Practice Address - Country:US
Practice Address - Phone:510-238-5400
Practice Address - Fax:510-238-5437
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA88914207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05-1822OtherFQHC MEDICARE PART A
CAHAP11991FOtherFPACT
CAZZZ79046ZOtherFQHC MEDICARE PART B
CAFHC11991FMedicaid