Provider Demographics
NPI:1730354820
Name:WULFSTAT, AMANDA A (MD)
Entity type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:A
Last Name:WULFSTAT
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:NOA
Other - Last Name:ANBAR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3580 CALIFORNIA ST
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94118-1725
Mailing Address - Country:US
Mailing Address - Phone:415-830-3090
Mailing Address - Fax:
Practice Address - Street 1:3580 CALIFORNIA ST
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94118-1725
Practice Address - Country:US
Practice Address - Phone:415-830-3090
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-29
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA103634207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine