Healthcare Provider Details

I. General information

NPI: 1609210244
Provider Name (Legal Business Name): AMANA AYOUB PSY.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2013
Last Update Date: 04/25/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 MOORPARK AVE STE 305
SAN JOSE CA
95128-2650
US

IV. Provider business mailing address

30 CHILD ST APT 4
SAN FRANCISCO CA
94133-3023
US

V. Phone/Fax

Practice location:
  • Phone: 408-975-2730
  • Fax:
Mailing address:
  • Phone: 415-244-4023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberCAPSY18214
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: