Individual
MR. GARY K TIA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2275 ARLINGTON DR, SAN LEANDRO, CA 94578-1132
(510) 317-1415
Mailing address
390 40TH ST, OAKLAND, CA 94609-2633
(415) 910-1763
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
225400000X
Rehabilitation Practitioner
Primary
—
—
Other
Enumeration date
08/19/2011
Last updated
02/03/2026
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