Healthcare Provider Details

I. General information

NPI: 1205954344
Provider Name (Legal Business Name): MS. AMBER LEE ANDERSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 09/14/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

349 E AVENUE K6
LANCASTER CA
93535-4508
US

IV. Provider business mailing address

18711 PATRONELLA AVE
TORRANCE CA
90504-5812
US

V. Phone/Fax

Practice location:
  • Phone: 661-723-4261
  • Fax: 661-723-6975
Mailing address:
  • Phone: 562-301-2884
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateCA
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number29308
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: