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NPI Code Detail

MEDICARE: ALYSSA ROSE AMENDOLA

MEDICARE: ALYSSA ROSE AMENDOLA
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
1106S00000XBehavior TechnicianCA

General Provider Information

NPI Number : 1942163803
Entity Type Code : Individual
Provider Name (Legal Business Name) : ALYSSA ROSE AMENDOLA
Provider Business Mailing Address
First Line : 11921 CORNELL LN
Second Line :
City : YUCAIPA
State : CA
Zip : 92399-3981
Country : US
Telephone Number : 909-253-8687
Fax Number :
Provider Business Practice Location Address
First Line : 11799 SEBASTIAN WAY STE 103
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91730-0708
Country : US
Telephone Number : 909-353-7547
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/08/2025
Last Update Date : 12/08/2025

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Directions to “ ALYSSA ROSE AMENDOLA ” Practice Location

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