Individual
AMANDA SUE CARLISLE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1001 POTRERO AVENUE, RM 2A21, SAN FRANCISCO, CA 94110
(415) 206-8509
(415) 285-2037
Mailing address
PO BOX 7464, SAN FRANCISCO, CA 94120-7464
(415) 206-8509
(415) 285-2037
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
Primary
G48329
CA
207LC0200X
Critical Care Medicine (Anesthesiology) Physician
G48329
CA
207R00000X
Internal Medicine Physician
G48329
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00G483290
—
CA
01
—
810000759
RAILROAD MEDICARE
CA
Enumeration date
05/23/2006
Last updated
11/23/2011
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