MEDICARE: AMANDA ASHOOR

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	106H00000X	Marriage & Family Therapist
2	106S00000X	Behavior Technician	RBT-16-26705	CA
3	106H00000X	Marriage & Family Therapist	148039	CA

General Provider Information

NPI Number	:	1407364920
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMANDA ASHOOR

Provider Business Mailing Address
First Line	:	5080 SHOREHAM PL STE 103
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-5931
Country	:	US
Telephone Number	:	858-272-2662
Fax Number	:

Provider Business Practice Location Address
First Line	:	5080 SHOREHAM PL STE 103
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92122-5931
Country	:	US
Telephone Number	:	858-272-2662
Fax Number	:

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

Provider Enumeration Date	:	01/18/2018
Last Update Date	:	10/04/2024

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Directions to “ AMANDA ASHOOR ” Practice Location

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