Organization
CRANIOFACIAL MEDICAL ASSOC OF CHRCO
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ELIO LEAVITT GIZZI MD (MEDICAL DIRECTOR)
(510) 428-3150
Entity
Organization
Contact information
Practice address
747 52ND ST, OAKLAND, CA 94609-1809
(510) 428-3150
(510) 601-3989
Mailing address
747 52ND ST, OAKLAND, CA 94609-1809
(510) 428-3150
(510) 601-3989
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
A549520
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A549520
CA. LICENSE NUMBER
CA
05
—
GR0095820
—
CA
Enumeration date
07/17/2006
Last updated
08/22/2020
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