Healthcare Provider Details

I. General information

NPI: 1679100614
Provider Name (Legal Business Name): AMY GUZDAR
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 ROWLAND WAY STE 200
NOVATO CA
94945-5056
US

IV. Provider business mailing address

PO BOX 276950
SACRAMENTO CA
95827-6950
US

V. Phone/Fax

Practice location:
  • Phone: 415-878-7200
  • Fax: 415-369-1387
Mailing address:
  • Phone: 866-681-0738
  • Fax: 916-854-3769

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA185363
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: