Provider Demographics
NPI:1922193275
Name:BABA, AMY E (DPM)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:E
Last Name:BABA
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:602 HUNTLEIGH DR
Mailing Address - Street 2:
Mailing Address - City:LAFAYETTE
Mailing Address - State:CA
Mailing Address - Zip Code:94549-5518
Mailing Address - Country:US
Mailing Address - Phone:925-284-3668
Mailing Address - Fax:925-283-3668
Practice Address - Street 1:602 HUNTLEIGH DR
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:CA
Practice Address - Zip Code:94549-5518
Practice Address - Country:US
Practice Address - Phone:925-284-3668
Practice Address - Fax:925-283-3668
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-04
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3350213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA480011444OtherPALMETTO GBA
CA000E33502Medicaid
CAT11646Medicare UPIN
CA000E33503Medicare ID - Type UnspecifiedPROVIDER ID