Healthcare Provider Details

I. General information

NPI: 1992164701
Provider Name (Legal Business Name): MR. SALVINO JOHN AMAYA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2016
Last Update Date: 12/02/2022
Certification Date: 12/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 HOSPITAL RD
SENORA CA
95370-4618
US

IV. Provider business mailing address

2 S GREEN ST
SONORA CA
95370-4618
US

V. Phone/Fax

Practice location:
  • Phone: 209-533-6245
  • Fax: 209-725-3775
Mailing address:
  • Phone: 209-533-6245
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: