Healthcare Provider Details

I. General information

NPI: 1689266652
Provider Name (Legal Business Name): AMANDA RAIN ORDAZ
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 08/19/2025
Certification Date: 08/19/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 E ORANGETHORPE AVE STE 200
FULLERTON CA
92831-5205
US

IV. Provider business mailing address

1501 E ORANGETHORPE AVE STE 200
FULLERTON CA
92831-5205
US

V. Phone/Fax

Practice location:
  • Phone: 714-254-8473
  • Fax:
Mailing address:
  • Phone: 714-254-8473
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number150908
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: