MEDICARE: MISS AMANDA CARNEIRO

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	133N00000X	Nutritionist

General Provider Information

NPI Number	:	1588385942
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS AMANDA CARNEIRO

Provider Business Mailing Address
First Line	:	4470 W. SUNSET BLVD
Second Line	:	SUITE 107, PMB 95606
City	:	LOS ANGELES
State	:	CA
Zip	:	90027
Country	:	US
Telephone Number	:	718-864-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4958 FOUNTAIN AVE
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90029-1535
Country	:	US
Telephone Number	:	718-864-8700
Fax Number	:

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

Provider Enumeration Date	:	09/06/2022
Last Update Date	:	09/06/2022

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Directions to “ MISS AMANDA CARNEIRO ” Practice Location

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