Healthcare Provider Details

I. General information

NPI: 1639549017
Provider Name (Legal Business Name): AMANDA MARIE PEREZ B.S
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/29/2015
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 W COLUMBUS ST
BAKERSFIELD CA
93301-1263
US

IV. Provider business mailing address

6333 SUGARLOAF LN
BAKERSFIELD CA
93307-1062
US

V. Phone/Fax

Practice location:
  • Phone: 661-328-0245
  • Fax:
Mailing address:
  • Phone: 661-749-3320
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number6862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: