Individual
SAMUEL HAILEMARIAM FANTAYE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
20642 JOHN DR, CASTRO VALLEY, CA 94546-5103
(510) 857-2559
Mailing address
20642 JOHN DR, CASTRO VALLEY, CA 94546-5103
Taxonomy
Speciality
Code
Description
License number
State
207QB0002X
Obesity Medicine (Family Medicine) Physician
A169452
CA
207R00000X
Internal Medicine Physician
A169452
CA
207RE0101X
Endocrinology, Diabetes & Metabolism Physician
Primary
A169452
CA
Other
Enumeration date
05/24/2017
Last updated
10/08/2024
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