Healthcare Provider Details

I. General information

NPI: 1114856317
Provider Name (Legal Business Name): TERRENCE AMIGLEO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/15/2026
Last Update Date: 05/15/2026
Certification Date: 05/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 TROUSDALE DR
BURLINGAME CA
94010-4506
US

IV. Provider business mailing address

205 OXFORD WAY
BELMONT CA
94002-2565
US

V. Phone/Fax

Practice location:
  • Phone: 650-696-5400
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164X00000X
TaxonomyLicensed Vocational Nurse
License Number717464
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: