Healthcare Provider Details

I. General information

NPI: 1073288841
Provider Name (Legal Business Name): AMANDA KUZAVA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 08/12/2021
Certification Date: 08/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8310 S VALLEY HWY STE 300
ENGLEWOOD CO
80112-5815
US

IV. Provider business mailing address

8885 RIO SAN DIEGO DR STE 340
SAN DIEGO CA
92108-1669
US

V. Phone/Fax

Practice location:
  • Phone: 619-795-9925
  • Fax:
Mailing address:
  • Phone: 619-795-9925
  • Fax: 877-602-5087

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: