Doctor Name: | JOANNE AMALA SUPERSAD |
NPI Number: | 1013096148 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | MD |
License Number: | G51939 |
Business Practice Address: | 200 Muir Rd Martinez, CA - 945534614 |
Business Phone Number: | 9253721000 |
Business Fax Number: | |
Mailing Address: | 1800 Harrison St Fl 7, OAKLAND |
State: | CA |
Postal Code: | 946123429 |
Phone Number: | 5106256262 |
Fax Number: | |
NPI Enumeration Date: | 11/02/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 2080A0000X |
License Number: | G51939 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Pediatrics |
Taxonomy Specialization: | Adolescent Medicine |
Taxonomy Definition: | A pediatrician who specializes in adolescent medicine is a multi-disciplinary healthcare specialist trained in the unique physical, psychological and social characteristics of adolescents, their healthcare problems and needs. |