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General NPI Number Information
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NPI Number | 1720768906
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Entity Type | Individual
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Provider Name | AIMEE J AMEZQUITA
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Gender | Female
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Dates
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Enumeration Date | 07/21/2023
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Last Update Date | 05/23/2024
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Provider Practice Location Address
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Address Line | 625 FAIR OAKS AVE STE 300
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City | SOUTH PASADENA
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State | CA
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Zip | 91030-5805
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Country | US
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Telephone | 626-940-9986
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Fax |
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Provider Business Mailing Address
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Address Line | 1150 E JAY ST
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City | CARSON
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State | CA
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Zip | 90745-3520
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Country | US
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Telephone |
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number |
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License Number State |
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