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NPI Code Detail

MEDICARE: AMANDA LEROY B.A

MEDICARE: AMANDA LEROY B.A
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
1390200000XStudent in an Organized Health Care Education/Training Program

General Provider Information

NPI Number : 1538296611
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA LEROY B.A
Provider Business Mailing Address
First Line : 1260 WENTWORTH AVE
Second Line :
City : PASADENA
State : CA
Zip : 91106-4448
Country : US
Telephone Number : 626-676-2010
Fax Number :
Provider Business Practice Location Address
First Line : 1433 S ROBERTSON BLVD
Second Line :
City : LOS ANGELES
State : CA
Zip : 90035-3414
Country : US
Telephone Number : 310-785-2121
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/27/2007
Last Update Date : 07/08/2007

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Directions to “ AMANDA LEROY B.A” Practice Location

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