Healthcare Provider Details

I. General information

NPI: 1538957774
Provider Name (Legal Business Name): AMY ADAIR HIETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/28/2025
Last Update Date: 06/24/2025
Certification Date: 06/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UC BERKELEY - TANG CENTER 2222 BANCROFT WAY
BERKELEY CA
94720-0001
US

IV. Provider business mailing address

2222 BANCROFT WAY
BERKELEY CA
94720-4301
US

V. Phone/Fax

Practice location:
  • Phone: 925-323-8611
  • Fax:
Mailing address:
  • Phone: 925-323-8611
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
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: