Healthcare Provider Details

I. General information

NPI: 1962058651
Provider Name (Legal Business Name): AMINA MOSTAFA FODA PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMINA FODA-KHOURY

II. Dates (important events)

Enumeration Date: 08/17/2019
Last Update Date: 07/20/2026
Certification Date: 07/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

675 18TH ST
SAN FRANCISCO CA
94143-4200
US

IV. Provider business mailing address

747 52ND ST
OAKLAND CA
94609-1809
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-7000
  • Fax:
Mailing address:
  • Phone: 510-428-3885
  • Fax: 510-601-3913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License NumberPSY35824
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPSY35824
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: