MEDICARE: AMANDA B. DIGIULIO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	99921	CA

General Provider Information

NPI Number	:	1093233785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA B. DIGIULIO

Provider Business Mailing Address
First Line	:	PO BOX 491702
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-8702
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	160 S THURSTON AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90049-3127
Country	:	US
Telephone Number	:	310-339-7359
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2017
Last Update Date	:	09/01/2017

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