Healthcare Provider Details

I. General information

NPI: 1437248937
Provider Name (Legal Business Name): AMY MARIA HUIBONHOA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 02/11/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2999 REGENT ST SUITE 201
BERKELEY CA
94705-2146
US

IV. Provider business mailing address

2999 REGENT ST SUITE 201
BERKELEY CA
94705-2146
US

V. Phone/Fax

Practice location:
  • Phone: 510-204-0965
  • Fax: 510-549-0334
Mailing address:
  • Phone: 510-204-0965
  • Fax: 510-549-0334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VG0400X
TaxonomyGynecology Physician
License NumberG77311
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: