Healthcare Provider Details

I. General information

NPI: 1629633532
Provider Name (Legal Business Name): MICHAEL ANTHONY HAMILTON II M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/06/2019
Last Update Date: 05/06/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

982 MISSION ST
SAN FRANCISCO CA
94103-2911
US

IV. Provider business mailing address

555 E EL CAMINO REAL APT 407
SUNNYVALE CA
94087-1958
US

V. Phone/Fax

Practice location:
  • Phone: 415-597-8000
  • Fax:
Mailing address:
  • Phone: 612-418-2195
  • 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: