Healthcare Provider Details

I. General information

NPI: 1942944434
Provider Name (Legal Business Name): AMANDA JO HURST I
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA JO HURST-CIESIELSKI RADT

II. Dates (important events)

Enumeration Date: 04/21/2022
Last Update Date: 04/21/2022
Certification Date: 04/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 N ESCONDIDO BLVD
ESCONDIDO CA
92026-2507
US

IV. Provider business mailing address

1341 N ESCONDIDO BLVD
ESCONDIDO CA
92026-2507
US

V. Phone/Fax

Practice location:
  • Phone: 760-747-1015
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1452881221
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: