Healthcare Provider Details

I. General information

NPI: 1689947806
Provider Name (Legal Business Name): AMY WHITE HOCKENBROCK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/18/2012
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2222 BANCROFT WAY
BERKELEY CA
94720-4301
US

IV. Provider business mailing address

900 LAFAYETTE ST STE 105
SANTA CLARA CA
95050-4966
US

V. Phone/Fax

Practice location:
  • Phone: 510-642-2000
  • Fax:
Mailing address:
  • Phone: 408-293-7767
  • Fax: 408-294-6595

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA120190
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: