Healthcare Provider Details

I. General information

NPI: 1386324267
Provider Name (Legal Business Name): AMYGDALA MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2023
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2230 W CHAPMAN AVE STE 214B
ORANGE CA
92868-2316
US

IV. Provider business mailing address

PO BOX 6080 ANAHEIM
ORANGE CA
92816
US

V. Phone/Fax

Practice location:
  • Phone: 714-712-0711
  • Fax: 657-224-4781
Mailing address:
  • Phone: 714-712-0711
  • Fax: 657-224-4781

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: TAQIALDEEN ZAMIL
Title or Position: CFO
Credential:
Phone: 714-712-0711