Healthcare Provider Details

I. General information

NPI: 1851749881
Provider Name (Legal Business Name): AMANDA LEA DEHART RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA LEA COPE PMHNP

II. Dates (important events)

Enumeration Date: 05/31/2016
Last Update Date: 09/09/2024
Certification Date: 09/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 MISSION AVE STE 130
OCEANSIDE CA
92058-7110
US

IV. Provider business mailing address

1251 SKY CREST GLN
ESCONDIDO CA
92029-3147
US

V. Phone/Fax

Practice location:
  • Phone: 760-305-4848
  • Fax:
Mailing address:
  • Phone: 951-236-2522
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number828346
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number95026676
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: