Healthcare Provider Details

I. General information

NPI: 1932902566
Provider Name (Legal Business Name): MICHAEL AMARILLAS APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/29/2025
Last Update Date: 06/20/2025
Certification Date: 06/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

830 SCENIC DR STE A
MODESTO CA
95350-6131
US

IV. Provider business mailing address

PO BOX 2502
TURLOCK CA
95381-2502
US

V. Phone/Fax

Practice location:
  • Phone: 209-558-7000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95034357
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: