Healthcare Provider Details

I. General information

NPI: 1063098655
Provider Name (Legal Business Name): AMANDA ALMANZA STEPHENS EMT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA ALMANZA EMT

II. Dates (important events)

Enumeration Date: 03/23/2021
Last Update Date: 03/31/2021
Certification Date: 03/31/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2960 S CHERRY AVE
FRESNO CA
93706-5445
US

IV. Provider business mailing address

1069 PINEWOOD AVE
SANGER CA
93657-8757
US

V. Phone/Fax

Practice location:
  • Phone: 559-213-3410
  • Fax:
Mailing address:
  • Phone: 559-213-3410
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code146N00000X
TaxonomyBasic Emergency Medical Technician
License NumberB06-7842
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: