MEDICARE: AMANDA ADEN PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	54796	CA

General Provider Information

NPI Number	:	1013435783
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ADEN PA

Provider Business Mailing Address
First Line	:	23701 MAIN ST
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90745-5745
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	23701 MAIN ST
Second Line	:
City	:	CARSON
State	:	CA
Zip	:	90745-5745
Country	:	US
Telephone Number	:	310-513-6707
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/01/2017
Last Update Date	:	01/30/2026

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Directions to “ AMANDA ADEN PA” Practice Location

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