Healthcare Provider Details

I. General information

NPI: 1811335672
Provider Name (Legal Business Name): HUMERA CHAUDHARY M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2013
Last Update Date: 04/13/2021
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2970 CAMINO DIABLO FL 3
LAFAYETTE CA
94597-4001
US

IV. Provider business mailing address

2970 CAMINO DIABLO FL 3
LAFAYETTE CA
94597-4001
US

V. Phone/Fax

Practice location:
  • Phone: 415-296-5290
  • Fax:
Mailing address:
  • Phone: 415-296-5290
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberLL35818
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License NumberA154361
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: