Healthcare Provider Details

I. General information

NPI: 1407304389
Provider Name (Legal Business Name): AMBER BUCKHOLZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 09/20/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

329 PIERCY RD
SAN JOSE CA
95138-1403
US

IV. Provider business mailing address

329 PIERCY RD
SAN JOSE CA
95138-1403
US

V. Phone/Fax

Practice location:
  • Phone: 408-692-5197
  • Fax:
Mailing address:
  • Phone: 408-692-5197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2355S0801X
TaxonomySpeech-Language Assistant
License Number3803
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: