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General NPI Number Information
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NPI Number | 1164602793
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Entity Type | Individual
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Provider Name | AMITY HALL PA
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Gender | Female
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Dates
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Enumeration Date | 11/12/2007
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Last Update Date | 04/15/2010
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Provider Practice Location Address
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Address Line | 875 BLAKE WILBUR
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City | STANFORD
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State | CA
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Zip | 94305-5820
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Country | US
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Telephone | 650-736-2066
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Fax | 650-736-0220
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Provider Business Mailing Address
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Address Line | 875 BLAKE WILBUR DRIVE
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City | STANFORD
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State | CA
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Zip | 94305-5820
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Country | US
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Telephone | 650-736-2066
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Fax | 650-736-0220
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA19463
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License Number State | CA
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