Healthcare Provider Details

I. General information

NPI: 1053549048
Provider Name (Legal Business Name): AUTUMN J BROADY M.D., M.P.H.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/29/2009
Last Update Date: 02/24/2021
Certification Date: 02/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5730 TELEGRAPH AVE STE 117
OAKLAND CA
94609-1710
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-6400
  • Fax: 415-369-1384
Mailing address:
  • Phone: 415-600-6400
  • Fax: 415-369-1384

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License Number1046715
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: