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General NPI Number Information
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NPI Number | 1750007431
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Entity Type | Individual
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Provider Name | AMANDA MARIE DALIA HAZELTINE DNP, MS, AGACNP-BC
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Gender | Female
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Dates
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Enumeration Date | 10/14/2022
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Last Update Date | 11/24/2025
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Provider Practice Location Address
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Address Line | 1500 DUARTE RD
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City | DUARTE
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State | CA
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Zip | 91010-3012
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Country | US
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Telephone | 800-826-4673
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Fax |
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Provider Business Mailing Address
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Address Line | 5767 W CENTURY BLVD STE 400
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City | LOS ANGELES
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State | CA
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Zip | 90045-5631
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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 | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95027398
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | RN2346236
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | NP95027398
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 95027398
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License Number State | CA
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