Healthcare Provider Details

I. General information

NPI: 1881816734
Provider Name (Legal Business Name): AMY DUCKWORTH D.P.M.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 12/22/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6403 COYLE AVE STE 170
CARMICHAEL CA
95608-0363
US

IV. Provider business mailing address

6403 COYLE AVE STE 170
CARMICHAEL CA
95608-0363
US

V. Phone/Fax

Practice location:
  • Phone: 916-965-4000
  • Fax: 916-965-4813
Mailing address:
  • Phone: 916-965-4000
  • Fax: 916-965-4813

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213ES0103X
TaxonomyFoot & Ankle Surgery Podiatrist
License NumberE4723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: