Healthcare Provider Details

I. General information

NPI: 1316641178
Provider Name (Legal Business Name): NATHAN AMEZCUA DC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2023
Last Update Date: 03/27/2023
Certification Date: 03/27/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 CORPORATE PLAZA DR
NEWPORT BEACH CA
92660-7914
US

IV. Provider business mailing address

12021 PATTON RD
DOWNEY CA
90242-2536
US

V. Phone/Fax

Practice location:
  • Phone: 949-873-0146
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111NR0400X
TaxonomyRehabilitation Chiropractor
License Number36568
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: