Healthcare Provider Details

I. General information

NPI: 1396683967
Provider Name (Legal Business Name): DJAMILA KADDOUR AMRAOUI
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2026
Last Update Date: 03/24/2026
Certification Date: 03/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11136 JARDIN PL
BLUE ASH OH
45241-6628
US

IV. Provider business mailing address

11136 JARDIN PL
BLUE ASH OH
45241-6628
US

V. Phone/Fax

Practice location:
  • Phone: 201-779-4253
  • Fax:
Mailing address:
  • Phone: 201-779-4253
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code172A00000X
TaxonomyDriver
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3747P1801X
TaxonomyPersonal Care Attendant
License Number
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: