MEDICARE: AMANDA YESENIA ALBUREZ

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1508647272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA YESENIA ALBUREZ

Provider Business Mailing Address
First Line	:	22800 LYONS AVE
Second Line	:
City	:	NEWHALL
State	:	CA
Zip	:	91321-6800
Country	:	US
Telephone Number	:	626-806-6093
Fax Number	:

Provider Business Practice Location Address
First Line	:	22800 LYONS AVE
Second Line	:
City	:	NEWHALL
State	:	CA
Zip	:	91321-6800
Country	:	US
Telephone Number	:	626-806-6093
Fax Number	:

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

Provider Enumeration Date	:	10/10/2023
Last Update Date	:	10/10/2023

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