Healthcare Provider Details

I. General information

NPI: 1790838860
Provider Name (Legal Business Name): ELLEN HUFBAUER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/19/2007
Last Update Date: 04/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2185 PACHECO ST
CONCORD CA
94520-2309
US

IV. Provider business mailing address

2185 PACHECO ST
CONCORD CA
94520-2309
US

V. Phone/Fax

Practice location:
  • Phone: 925-887-5396
  • Fax: 925-887-5269
Mailing address:
  • Phone: 925-887-5396
  • Fax: 925-887-5269

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberA72145
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: