Healthcare Provider Details

I. General information

NPI: 1851593149
Provider Name (Legal Business Name): LOUISE HOM, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2007
Last Update Date: 11/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20130 LAKE CHABOT RD STE 202
CASTRO VALLEY CA
94546-5340
US

IV. Provider business mailing address

20130 LAKE CHABOT RD STE 202
CASTRO VALLEY CA
94546-5340
US

V. Phone/Fax

Practice location:
  • Phone: 510-583-8192
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208600000X
TaxonomySurgery Physician
License Number
License Number State

VIII. Authorized Official

Name: LOUISE HOM
Title or Position: PRESIDENT
Credential: M.D.
Phone: 510-583-8192