Amy DO

Key facts

NPI

1114757267

Entity type

Individual (NPI type 1)

Primary specialty

Student in an Organized Health Care Education/Training Program 390200000X

Practice address

1163 Banyan Way
Pacifica, CA 94044-4343

Phone

(669) 264-4975

NPI assigned

Aug 5, 2024

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)

No

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Aug 5, 2024.

{
    "created_epoch": "1722816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1722816000000",
    "number": "1114757267",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1163 BANYAN WAY",
            "city": "PACIFICA",
            "state": "CA",
            "postal_code": "940444343",
            "telephone_number": "669-264-4975"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1163 BANYAN WAY",
            "city": "PACIFICA",
            "state": "CA",
            "postal_code": "940444343",
            "telephone_number": "669-264-4975"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "DO",
        "first_name": "AMY",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-08-05",
        "last_updated": "2024-08-05",
        "certification_date": "2024-08-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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All providers in Pacifica, CA · Student in an Organized Health Care Education/Training Program in California