Healthcare Provider Details

I. General information

NPI: 1730354820
Provider Name (Legal Business Name): AMANDA A. WULFSTAT MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA NOA ANBAR

II. Dates (important events)

Enumeration Date: 04/29/2008
Last Update Date: 08/17/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3580 CALIFORNIA ST SUITE 101
SAN FRANCISCO CA
94118-1725
US

IV. Provider business mailing address

3580 CALIFORNIA ST SUITE 101
SAN FRANCISCO CA
94118-1725
US

V. Phone/Fax

Practice location:
  • Phone: 415-830-3090
  • Fax:
Mailing address:
  • Phone: 415-830-3090
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA103634
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: