Healthcare Provider Details

I. General information

NPI: 1689506149
Provider Name (Legal Business Name): MARI AMAKASU
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/01/2026
Last Update Date: 06/01/2026
Certification Date: 05/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

124 NICKEL
IRVINE CA
92618-0830
US

IV. Provider business mailing address

124 NICKEL
IRVINE CA
92618-0830
US

V. Phone/Fax

Practice location:
  • Phone: 714-251-3985
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number9760
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: