Healthcare Provider Details

I. General information

NPI: 1013435783
Provider Name (Legal Business Name): AMANDA ADEN PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/01/2017
Last Update Date: 12/17/2025
Certification Date: 12/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23701 MAIN ST
CARSON CA
90745-5745
US

IV. Provider business mailing address

1618 E WASHINGTON AVE
ORANGE CA
92866-2214
US

V. Phone/Fax

Practice location:
  • Phone: 310-513-6707
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number54796
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: