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NPI Code Detail

MEDICARE: AMANDA HENRIQUES

MEDICARE: AMANDA HENRIQUES
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
1235Z00000XSpeech-Language Pathologist30383CA

General Provider Information

NPI Number : 1275232100
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA HENRIQUES
Provider Business Mailing Address
First Line : 405 W ELK AVE APT 3
Second Line :
City : GLENDALE
State : CA
Zip : 91204-1521
Country : US
Telephone Number : 310-872-0508
Fax Number :
Provider Business Practice Location Address
First Line : 16255 VENTURA BLVD STE 1015
Second Line :
City : ENCINO
State : CA
Zip : 91436-2318
Country : US
Telephone Number : 818-741-7014
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/28/2023
Last Update Date : 02/28/2023

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Directions to “ AMANDA HENRIQUES ” Practice Location

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