Healthcare Provider Details

I. General information

NPI: 1912900499
Provider Name (Legal Business Name): DEBRA WALHOF
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2005
Last Update Date: 12/15/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

250 BON AIR RD
GREENBRAE CA
94904-1702
US

IV. Provider business mailing address

300 PROFESSIONAL CENTER DR STE 311
NOVATO CA
94947-4334
US

V. Phone/Fax

Practice location:
  • Phone: 415-448-1500
  • Fax: 415-892-8732
Mailing address:
  • Phone: 415-448-1500
  • Fax: 415-892-8732

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG069664
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: