Healthcare Provider Details

I. General information

NPI: 1174360374
Provider Name (Legal Business Name): AMY ELIZABETH DALLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 07/21/2025
Certification Date: 07/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1410 BONITA AVE
BERKELEY CA
94709-1909
US

IV. Provider business mailing address

1028 LEWELLING CT
ALAMEDA CA
94501-5314
US

V. Phone/Fax

Practice location:
  • Phone: 510-526-4765
  • Fax: 510-526-2887
Mailing address:
  • Phone: 650-520-9148
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: