Healthcare Provider Details

I. General information

NPI: 1174360374
Provider Name (Legal Business Name): AMY ELIZABETH DALLI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2024
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

516 31ST ST
OAKLAND CA
94609-3204
US

IV. Provider business mailing address

1450 SUTTER ST # 520
SAN FRANCISCO CA
94109-5418
US

V. Phone/Fax

Practice location:
  • Phone: 510-526-4765
  • Fax: 510-526-2887
Mailing address:
  • Phone: 510-626-0083
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number160751
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: