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General NPI Number Information
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NPI Number | 1134839244
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Entity Type | Individual
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Provider Name | AMANDA BROOKE ISRAEL DDS
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Gender | Female
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Dates
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Enumeration Date | 11/29/2022
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Last Update Date | 11/29/2022
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Provider Practice Location Address
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Address Line | 10861 CHERRY ST
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City | LOS ALAMITOS
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State | CA
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Zip | 90720-5402
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Country | US
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Telephone | 562-430-3998
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Fax |
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Provider Business Mailing Address
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Address Line | 12665 VILLAGE LN APT 2401
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City | PLAYA VISTA
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State | CA
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Zip | 90094-2835
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Country | US
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Telephone | 562-212-6477
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223X0400X
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Taxonomy Name | Orthodontics and Dentofacial Orthopedics Dentistry
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License Number | 105680
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License Number State | CA
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