Healthcare Provider Details

I. General information

NPI: 1548848377
Provider Name (Legal Business Name): AMANDA PALMER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 12/01/2025
Certification Date: 12/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 CONDOR DR
RIALTO CA
92377-4715
US

IV. Provider business mailing address

116 CONDOR DR
RIALTO CA
92377-4715
US

V. Phone/Fax

Practice location:
  • Phone: 909-496-8745
  • Fax:
Mailing address:
  • Phone: 909-496-8745
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-25-16629
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: