Healthcare Provider Details

I. General information

NPI: 1356765598
Provider Name (Legal Business Name): MS. AMANDA NABAYAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2014
Last Update Date: 02/12/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8555 FLORENCE AVE
DOWNEY CA
90240-4014
US

IV. Provider business mailing address

2740 FAUST AVE
LONG BEACH CA
90815-1339
US

V. Phone/Fax

Practice location:
  • Phone: 562-923-9351
  • Fax:
Mailing address:
  • Phone: 310-780-1063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225XH1200X
TaxonomyHand Occupational Therapist
License Number14053
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number14053
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number14053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: