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General NPI Number Information
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NPI Number | 1427522713
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Entity Type | Individual
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Provider Name | AMANDA NICOLE BISHARAT
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Gender | Female
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Dates
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Enumeration Date | 01/19/2019
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Last Update Date | 12/17/2024
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Provider Practice Location Address
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Address Line | 23929 MCBEAN PKWY STE 215
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City | VALENCIA
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State | CA
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Zip | 91355-4468
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Country | US
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Telephone | 661-799-2542
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Fax |
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Provider Business Mailing Address
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Address Line | 3401 N OSAGE AVE
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City | CHICAGO
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State | IL
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Zip | 60634-2954
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Country | US
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Telephone | 773-803-6023
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA56005
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License Number State | CA
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