Healthcare Provider Details

I. General information

NPI: 1285453068
Provider Name (Legal Business Name): AMANDA MAI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/08/2024
Last Update Date: 10/08/2024
Certification Date: 10/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

482 N ROSEMEAD BLVD STE 207
PASADENA CA
91107-3053
US

IV. Provider business mailing address

200 W ATARA ST
MONROVIA CA
91016-4717
US

V. Phone/Fax

Practice location:
  • Phone: 747-477-2019
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number149688
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: