Healthcare Provider Details

I. General information

NPI: 1376155515
Provider Name (Legal Business Name): KAREN MAGALI AMENERO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/19/2020
Last Update Date: 08/06/2021
Certification Date: 08/06/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3939 ATLANTIC AVE STE 103
LONG BEACH CA
90807-3529
US

IV. Provider business mailing address

5258 ALDRICH RD
SOUTH GATE CA
90280-6441
US

V. Phone/Fax

Practice location:
  • Phone: 562-264-6001
  • Fax:
Mailing address:
  • Phone: 323-715-7433
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: