Healthcare Provider Details

I. General information

NPI: 1588117089
Provider Name (Legal Business Name): AMANDA BAUS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/01/2016
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E MOUNTAIN VIEW ST SUITE 100
BARSTOW CA
92311-2814
US

IV. Provider business mailing address

309 E MOUNTAIN VIEW ST STE 100
BARSTOW CA
92311-2814
US

V. Phone/Fax

Practice location:
  • Phone: 760-256-7279
  • Fax:
Mailing address:
  • Phone: 760-256-7279
  • Fax: 760-255-2105

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberD6779422
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: