Healthcare Provider Details

I. General information

NPI: 1912393224
Provider Name (Legal Business Name): AMY BACA M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/13/2015
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 CASTRO ST STE 402
SAN FRANCISCO CA
94114-1040
US

IV. Provider business mailing address

325 DISTEL CIR
LOS ALTOS CA
94022-1408
US

V. Phone/Fax

Practice location:
  • Phone: 415-600-4750
  • Fax: 415-369-1314
Mailing address:
  • Phone: 415-600-4750
  • Fax: 415-369-1314

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number1165025
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number1165025
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: