Healthcare Provider Details

I. General information

NPI: 1629140454
Provider Name (Legal Business Name): ANN K. EASTMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ANN MARIE KROVOZA

II. Dates (important events)

Enumeration Date: 11/15/2006
Last Update Date: 04/18/2025
Certification Date: 04/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1537 EUCLID AVE
BERKELEY CA
94708-1906
US

IV. Provider business mailing address

14355 MIRANDA WAY
LOS ALTOS HILLS CA
94022-2032
US

V. Phone/Fax

Practice location:
  • Phone: 510-993-7907
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG63786
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: