MEDICARE: MARK A AMPARO

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	103TH0100X	Health Service Psychologist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396374054
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MARK A AMPARO

Provider Business Mailing Address
First Line	:	PO BOX 939043
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92193-9043
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5222 BALBOA AVE STE 33
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92117-6953
Country	:	US
Telephone Number	:	858-874-8868
Fax Number	:

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

Provider Enumeration Date	:	04/05/2020
Last Update Date	:	04/05/2020

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Directions to “ MARK A AMPARO ” Practice Location

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