Provider Demographics
NPI:1255451357
Name:PIEDMONT AVENUE CLINIC
Entity type:Organization
Organization Name:PIEDMONT AVENUE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIPL.AC, CCH
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DONNER
Authorized Official - Suffix:
Authorized Official - Credentials:LAC
Authorized Official - Phone:510-655-0555
Mailing Address - Street 1:3927 PIEDMONT AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94611-5351
Mailing Address - Country:US
Mailing Address - Phone:510-655-0555
Mailing Address - Fax:510-655-4982
Practice Address - Street 1:3927 PIEDMONT AVE
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94611-5351
Practice Address - Country:US
Practice Address - Phone:510-655-0555
Practice Address - Fax:510-655-4982
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC3010171100000X, 175L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Not Answered175L00000XOther Service ProvidersHomeopathGroup - Multi-Specialty