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NPI Code Detail

MEDICARE: PURI AMANAH CELES-MENDIOLA

MEDICARE: PURI AMANAH CELES-MENDIOLA
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
1106S00000XBehavior TechnicianF2413751CA

General Provider Information

NPI Number : 1396462453
Entity Type Code : Individual
Provider Name (Legal Business Name) : PURI AMANAH CELES-MENDIOLA
Provider Business Mailing Address
First Line : 5850 GRANITE PKWY STE 600
Second Line :
City : PLANO
State : TX
Zip : 75024-6753
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3605 OCEAN RANCH BLVD STE 100
Second Line :
City : OCEANSIDE
State : CA
Zip : 92056-2696
Country : US
Telephone Number : 442-325-3819
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2022
Last Update Date : 10/20/2022

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Directions to “ PURI AMANAH CELES-MENDIOLA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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