Healthcare Provider Details

I. General information

NPI: 1487569497
Provider Name (Legal Business Name): AMANDA MURGUIA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2026
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1460 ROLLING HILLS DR
FULLERTON CA
92835-2008
US

IV. Provider business mailing address

1349 S COUNTRY WAY
LA HABRA CA
90631-6985
US

V. Phone/Fax

Practice location:
  • Phone: 714-447-7795
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number12097
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: