Provider Demographics
NPI:1336228469
Name:LIVELY HAMILL, ALICE J (DO)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:J
Last Name:LIVELY HAMILL
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:J
Other - Last Name:LIVELY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DO
Mailing Address - Street 1:1800 HARRISON ST FL 7
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94612-3466
Mailing Address - Country:US
Mailing Address - Phone:510-625-6262
Mailing Address - Fax:
Practice Address - Street 1:19000 HOMESTEAD RD BLDG 12ND
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-0712
Practice Address - Country:US
Practice Address - Phone:408-366-4322
Practice Address - Fax:408-366-4336
Is Sole Proprietor?:No
Enumeration Date:2006-11-02
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8708207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A8708OtherMEDICARE ID
H46069Medicare UPIN