Healthcare Provider Details

I. General information

NPI: 1619681087
Provider Name (Legal Business Name): AMANDA ROSE BOSKE CMPSS, RDAT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA ROSE KAZ

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

47915 OASIS ST UNIT B
INDIO CA
92201-6950
US

IV. Provider business mailing address

2500 N PALM CANYON DR STE A4
PALM SPRINGS CA
92262-1866
US

V. Phone/Fax

Practice location:
  • Phone: 760-209-6324
  • Fax:
Mailing address:
  • Phone: 760-424-5602
  • Fax: 760-670-2734

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberR1613790525
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License NumberMPSS-OVETLI
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: