Healthcare Provider Details

I. General information

NPI: 1619566254
Provider Name (Legal Business Name): NATALIE AMBRIZ PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2021
Last Update Date: 08/29/2022
Certification Date: 08/29/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 HEGENBERGER RD STE 100
OAKLAND CA
94621-1452
US

IV. Provider business mailing address

333 HEGENBERGER RD STE 100
OAKLAND CA
94621-1452
US

V. Phone/Fax

Practice location:
  • Phone: 510-638-0701
  • Fax: 510-638-1209
Mailing address:
  • Phone: 510-638-0701
  • Fax: 510-638-1209

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number60567
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: