Healthcare Provider Details

I. General information

NPI: 1578913091
Provider Name (Legal Business Name): KARLA AMAYA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/15/2016
Last Update Date: 06/15/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10418 VALLEY BLVD
EL MONTE CA
91731-3600
US

IV. Provider business mailing address

10418 VALLEY BLVD
EL MONTE CA
91731-3600
US

V. Phone/Fax

Practice location:
  • Phone: 626-258-1600
  • Fax:
Mailing address:
  • Phone: 626-258-1600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License Number714011
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: