Healthcare Provider Details

I. General information

NPI: 1609606961
Provider Name (Legal Business Name): AMAIYA GILLIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/02/2024
Last Update Date: 08/02/2024
Certification Date: 08/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1900 S NORFOLK ST
SAN MATEO CA
94403-1164
US

IV. Provider business mailing address

160 ALBION ST
SAN FRANCISCO CA
94110-1128
US

V. Phone/Fax

Practice location:
  • Phone: 650-242-0179
  • Fax:
Mailing address:
  • Phone: 408-763-6284
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: