Healthcare Provider Details

I. General information

NPI: 1679392070
Provider Name (Legal Business Name): AMALI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 10/29/2024
Certification Date: 10/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

432 HOTZ ST
SPRING VALLEY CA
91977-5709
US

IV. Provider business mailing address

826 ORANGE AVENUE PMB 508
CORONADO CA
92118
US

V. Phone/Fax

Practice location:
  • Phone: 619-837-2072
  • Fax:
Mailing address:
  • Phone: 619-837-2072
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State

VIII. Authorized Official

Name: AMEL ESPOSITO
Title or Position: CEO & GENERAL COUNSEL
Credential: J.D.
Phone: 619-837-2072