Healthcare Provider Details

I. General information

NPI: 1679482087
Provider Name (Legal Business Name): HERMELA AMANUEL
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/02/2026
Last Update Date: 09/02/2026
Certification Date: 09/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11303 W WASHINGTON BLVD
LOS ANGELES CA
90066-6003
US

IV. Provider business mailing address

11080 W OLYMPIC BLVD
LOS ANGELES CA
90064-1937
US

V. Phone/Fax

Practice location:
  • Phone: 310-462-5380
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code373H00000X
TaxonomyDay Training/Habilitation Specialist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: