Individual
PHILIP STALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RN
Contact information
Practice address
1890 ALCATRAZ AVENUE, BERKELEY, CA 94608
(510) 981-7643
Mailing address
1890 ALCATRAZ AVE, BERKELEY, CA 94703-2715
(510) 981-7643
Taxonomy
Speciality
Code
Description
License number
State
163WP0809X
Adult Psychiatric/Mental Health Registered Nurse
Primary
95048577
CA
Other
Enumeration date
06/14/2017
Last updated
06/14/2017
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