Healthcare Provider Details

I. General information

NPI: 1013715804
Provider Name (Legal Business Name): AMANDA SIMONS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/06/2025
Certification Date: 03/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 BUENA VISTA AVE
ALAMEDA CA
94501-1610
US

IV. Provider business mailing address

688 FAIRMOUNT AVE APT 4
OAKLAND CA
94611-5369
US

V. Phone/Fax

Practice location:
  • Phone: 510-748-4002
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171400000X
TaxonomyHealth & Wellness Coach
License Number76F0C8EC4B
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: