Individual
EBONY ELISE INGRAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
426 17TH ST STE 2, OAKLAND, CA 94612-2820
(510) 433-8600
Mailing address
426 17TH ST FL 2, OAKLAND, CA 94612-2820
(510) 433-8600
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
—
—
247200000X
Other Technician
Primary
—
—
Other
Enumeration date
09/22/2021
Last updated
10/15/2025
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