Healthcare Provider Details

I. General information

NPI: 1740693506
Provider Name (Legal Business Name): FAHZIA AMTHUL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/09/2014
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 VAN NESS AVENUE NICU - 5TH FLOOR
SAN FRANCISCO CA
94109-3561
US

IV. Provider business mailing address

300 HILLER ST
BELMONT CA
94002-2519
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-6211
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA130200
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: