Healthcare Provider Details

I. General information

NPI: 1407070683
Provider Name (Legal Business Name): AMANDA LEE HOLBROOK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 09/28/2020
Certification Date: 09/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

375 DIXMYTH AVE
CINCINNATI OH
45220-2475
US

IV. Provider business mailing address

360 3RD ST STE 425
SAN FRANCISCO CA
94107-2164
US

V. Phone/Fax

Practice location:
  • Phone: 513-862-2573
  • Fax: 513-852-8525
Mailing address:
  • Phone: 800-929-0926
  • Fax: 833-914-0435

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number51328
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License Number51328
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: