Healthcare Provider Details

I. General information

NPI: 1780699538
Provider Name (Legal Business Name): AMY A. HALIO MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2006
Last Update Date: 08/23/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 E. LEWELLING BLVD RM S-5
SAN LORENZO CA
94580-1732
US

IV. Provider business mailing address

P.O. BOX 22210
OAKLAND CA
94623-2210
US

V. Phone/Fax

Practice location:
  • Phone: 510-317-3167
  • Fax: 510-276-5483
Mailing address:
  • Phone: 510-535-4000
  • Fax: 510-535-4225

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberG57684
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: