Healthcare Provider Details

I. General information

NPI: 1508687195
Provider Name (Legal Business Name): AMANDA CAZIMI NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2024
Last Update Date: 10/17/2024
Certification Date: 10/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 CLEMENT ST
SAN FRANCISCO CA
94118-1031
US

IV. Provider business mailing address

5280 TURNER RD
SEBASTOPOL CA
95472-6247
US

V. Phone/Fax

Practice location:
  • Phone: 628-295-6255
  • Fax:
Mailing address:
  • Phone: 415-794-0419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code202D00000X
TaxonomyIntegrative Medicine Physician
License NumberNP95031686
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: