Healthcare Provider Details

I. General information

NPI: 1912444076
Provider Name (Legal Business Name): MANUEL JOSE AMADOR M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/27/2017
Last Update Date: 01/27/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9415 CAMPUS POINT DR
LA JOLLA CA
92093-0946
US

IV. Provider business mailing address

5063 MILLAY CT
CARLSBAD CA
92008-3869
US

V. Phone/Fax

Practice location:
  • Phone: 858-534-6290
  • Fax:
Mailing address:
  • Phone: 760-448-0722
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: