Healthcare Provider Details

I. General information

NPI: 1992292148
Provider Name (Legal Business Name): MAAME-AMA BAFFOE-BONNIE M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMA BAFFOE-BONNIE M.D.

II. Dates (important events)

Enumeration Date: 04/13/2018
Last Update Date: 08/17/2021
Certification Date: 08/17/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3200 KEARNEY ST
FREMONT CA
94538-2299
US

IV. Provider business mailing address

3200 KEARNEY ST
FREMONT CA
94538-2299
US

V. Phone/Fax

Practice location:
  • Phone: 510-490-1222
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA163572
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: