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1629554795 NPI number — AMANDA ELIZABETH ANGUIANO

NPI Number: 1629554795
Health Care Provider/Practitioner: AMANDA ELIZABETH ANGUIANO

Information about “1629554795” NPI (AMANDA ELIZABETH ANGUIANO) exists in 1629554795 in HTML format HTML  |  1629554795 in plain Text format TXT  |  1629554795 in PDF (Portable Document Format) PDF  |  1629554795 in an XML format XML  formats.

NPI Number : 1629554795 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1629554795",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "ANGUIANO",
    "FirstName": "AMANDA",
    "MiddleName": "ELIZABETH",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": "SMITH",
    "OtherFirstName": "AMANDA",
    "OtherMiddleName": "ELIZABETH",
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": "AMANDA SMITH",
    "OtherLastNameTypeCode": "1",
    "FirstLineMailingAddress": "240 E ARCADE ST",
    "SecondLineMailingAddress": null,
    "MailingAddressCityName": "STOCKTON",
    "MailingAddressStateName": "CA",
    "MailingAddressPostalCode": "95204-3704",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "209-649-9938",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "2423 W MARCH LN",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "STOCKTON",
    "PracticeLocationAddressStateName": "CA",
    "PracticeLocationAddressPostalCode": "95207-6469",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "209-478-9862",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "07/12/2018",
    "LastUpdateDate": "06/04/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "106S00000X",
          "TaxonomyName": "Behavior Technician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "172V00000X",
          "TaxonomyName": "Community Health Worker",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "373H00000X",
          "TaxonomyName": "Day Training/Habilitation Specialist",
          "LicenseNumber": null,
          "LicenseNumberStateCode": "CA",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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