Healthcare Provider Details

I. General information

NPI: 1104840586
Provider Name (Legal Business Name): BARBARA HUGHES KOSTICK M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

38069 MARTHA AVE SUITE 300
FREMONT CA
94536-3811
US

IV. Provider business mailing address

38069 MARTHA AVE SUITE 300
FREMONT CA
94536-3811
US

V. Phone/Fax

Practice location:
  • Phone: 510-608-4800
  • Fax:
Mailing address:
  • Phone: 510-608-4800
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberG24535
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: