Healthcare Provider Details

I. General information

NPI: 1174269351
Provider Name (Legal Business Name): AMELIE SPANGENBERG MBBS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/10/2022
Last Update Date: 06/30/2025
Certification Date: 06/29/2025
Deactivation Date: 03/20/2023
Reactivation Date: 03/23/2023

III. Provider practice location address

1701 DIVISADERO STREET, ROOM 4 20 UCSF, DEPARTMENT OF DERMATOLOGY
SAN FRANCISCO CA
94115
US

IV. Provider business mailing address

1701 DIVISADERO STREET, ROOM 4 20 UCSF, DEPARTMENT OF DERMATOLOGY
SAN FRANCISCO CA
94115
US

V. Phone/Fax

Practice location:
  • Phone: 415-353-7880
  • Fax:
Mailing address:
  • Phone: 415-353-7880
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: