Healthcare Provider Details

I. General information

NPI: 1013189554
Provider Name (Legal Business Name): AMANDA BALDIZAN NARVAEZ ICADC, CADC-II, MHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA RAE BALDIZAN CADC-II, ICADC, MHRS

II. Dates (important events)

Enumeration Date: 03/25/2008
Last Update Date: 08/08/2025
Certification Date: 08/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1905 E BEAMER ST
WOODLAND CA
95776-6257
US

IV. Provider business mailing address

PO BOX 77
BRODERICK CA
95605-0077
US

V. Phone/Fax

Practice location:
  • Phone: 530-631-0814
  • Fax: 530-447-1222
Mailing address:
  • Phone: 916-607-4081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225400000X
TaxonomyRehabilitation Practitioner
License NumberA020470815
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA020470815
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License NumberA020470815
License Number StateCA
# 5
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: