Healthcare Provider Details

I. General information

NPI: 1861993875
Provider Name (Legal Business Name): AMANDA MARIE CORTEZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA MARIE BARRERA

II. Dates (important events)

Enumeration Date: 02/24/2018
Last Update Date: 04/19/2023
Certification Date: 04/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6601 MCDIVITT DR
BAKERSFIELD CA
93313-2049
US

IV. Provider business mailing address

21600 OXNARD ST STE 1800
WOODLAND HILLS CA
91367-7807
US

V. Phone/Fax

Practice location:
  • Phone: 661-520-9292
  • Fax:
Mailing address:
  • Phone: 818-345-2345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-49411
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: