=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508732660
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMANDA MARIE DE LA CRUZ
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/15/2025
-----------------------------------------------------
Last Update Date | 10/24/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 26675 PLAINFIELD ST
-----------------------------------------------------
City | ESPARTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95627-2192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-908-5970
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 26675 PLAINFIELD ST
-----------------------------------------------------
City | ESPARTO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 95627-2192
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 530-908-5970
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171400000X
-----------------------------------------------------
Taxonomy Name | Health & Wellness Coach
-----------------------------------------------------
License Number | D6C0401DF6
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------