MEDICARE: AMANDA ZAMANI ATC

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	2255A2300X	Athletic Trainer	2000010014	CA

General Provider Information

NPI Number	:	1154729978
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ZAMANI ATC

Provider Business Mailing Address
First Line	:	835 VIA COLINAS
Second Line	:
City	:	WESTLAKE VILLAGE
State	:	CA
Zip	:	91362-5045
Country	:	US
Telephone Number	:	818-487-6655
Fax Number	:

Provider Business Practice Location Address
First Line	:	3700 COLDWATER CANYON AVE
Second Line	:
City	:	STUDIO CITY
State	:	CA
Zip	:	91604-2301
Country	:	US
Telephone Number	:	818-487-6655
Fax Number	:

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

Provider Enumeration Date	:	12/10/2014
Last Update Date	:	12/10/2014

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