Healthcare Provider Details

I. General information

NPI: 1790349090
Provider Name (Legal Business Name): AMY MELISSA HOFMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/23/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1720 S AMPHLETT BLVD # S110
SAN MATEO CA
94402-2702
US

IV. Provider business mailing address

1720 S AMPHLETT BLVD # S110
SAN MATEO CA
94402-2702
US

V. Phone/Fax

Practice location:
  • Phone: 650-727-2511
  • Fax:
Mailing address:
  • Phone: 650-727-2511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: