Healthcare Provider Details

I. General information

NPI: 1376474619
Provider Name (Legal Business Name): AMANDA KAMIYAMA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMY KAMIYAMA

II. Dates (important events)

Enumeration Date: 05/26/2026
Last Update Date: 05/26/2026
Certification Date: 05/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 W LUGONIA AVE
REDLANDS CA
92374-2234
US

IV. Provider business mailing address

30145 FRONTERA DEL SUR
HIGHLAND CA
92346-5936
US

V. Phone/Fax

Practice location:
  • Phone: 909-938-1727
  • Fax:
Mailing address:
  • Phone: 909-938-1727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License NumberSP10376
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: