Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003000951 |
---|---|
Provider Name | Mr. Macheo Kahil Payne |
First Address | Oakland, CA 94602-2529 |
Second Address | Oakland, CA 94605-4735 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/09/2007 |
Last Update Date | 04/09/2007 |