=====================================================
General NPI Number Information
=====================================================
NPI Number | 1336008010
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MATTHEW EDWARD AMAYA
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/19/2026
-----------------------------------------------------
Last Update Date | 01/19/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 495 E RINCON ST STE 209
-----------------------------------------------------
City | CORONA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92879-1379
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-821-1491
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 28748 LIVE OAK RD
-----------------------------------------------------
City | HIGHLAND
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92346-5236
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 909-649-3525
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106S00000X
-----------------------------------------------------
Taxonomy Name | Behavior Technician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------