Healthcare Provider Details

I. General information

NPI: 1417873696
Provider Name (Legal Business Name): EGBOSIUBA MD PSYCHIATRY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/24/2026
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

851 FREMONT AVE STE 108
LOS ALTOS CA
94024-5602
US

IV. Provider business mailing address

851 FREMONT AVE STE 108
LOS ALTOS CA
94024-5602
US

V. Phone/Fax

Practice location:
  • Phone: 650-262-1564
  • Fax:
Mailing address:
  • Phone: 650-262-1564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: LINDA CHINELO EGBOSIUBA
Title or Position: PHYSICIAN
Credential: MD, MBA
Phone: 650-262-1564