Healthcare Provider Details

I. General information

NPI: 1356176085
Provider Name (Legal Business Name): MARLEINA AMAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/03/2024
Last Update Date: 08/26/2026
Certification Date: 08/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4900 N GRAND AVE APT 138
COVINA CA
91724-1090
US

IV. Provider business mailing address

4900 N GRAND AVE APT 138
COVINA CA
91724-1090
US

V. Phone/Fax

Practice location:
  • Phone: 626-533-8409
  • Fax:
Mailing address:
  • Phone: 626-533-8409
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code374J00000X
TaxonomyDoula
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: