Healthcare Provider Details

I. General information

NPI: 1023893716
Provider Name (Legal Business Name): AMANDA LANAE HAUPTMANN PHILLIPS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA LANAE HAUPTMANN

II. Dates (important events)

Enumeration Date: 08/30/2023
Last Update Date: 09/17/2025
Certification Date: 09/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1722 S LEWIS RD
CAMARILLO CA
93012-8520
US

IV. Provider business mailing address

1722 S LEWIS RD
CAMARILLO CA
93012-8520
US

V. Phone/Fax

Practice location:
  • Phone: 805-366-4040
  • Fax:
Mailing address:
  • Phone: 805-366-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number14941
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: