Healthcare Provider Details

I. General information

NPI: 1053792531
Provider Name (Legal Business Name): AMARRA MCHALE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2015
Last Update Date: 10/18/2021
Certification Date: 10/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4650 W SUNSET BLVD # 38
LOS ANGELES CA
90027-6062
US

IV. Provider business mailing address

7282 3/4 FOUNTAIN AVE
WEST HOLLYWOOD CA
90046-5722
US

V. Phone/Fax

Practice location:
  • Phone: 213-399-4564
  • Fax:
Mailing address:
  • Phone: 213-399-4564
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95002508
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number95002508
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: