Healthcare Provider Details

I. General information

NPI: 1689168981
Provider Name (Legal Business Name): MARYJANE TATIANA AMAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2018
Last Update Date: 07/08/2026
Certification Date: 07/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13079 ARTESIA BLVD STE B210
CERRITOS CA
90703-1486
US

IV. Provider business mailing address

13079 ARTESIA BLVD STE B210
CERRITOS CA
90703-1486
US

V. Phone/Fax

Practice location:
  • Phone: 844-422-2435
  • Fax: 562-219-7458
Mailing address:
  • Phone: 844-422-2435
  • Fax: 562-219-7458

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-91069
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: