MEDICARE: CHARLES AGUSTIN AMADOR PA-C

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	363A00000X	Physician Assistant	51709	CA

General Provider Information

NPI Number	:	1659786242
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHARLES AGUSTIN AMADOR PA-C

Provider Business Mailing Address
First Line	:	4126 NORMAL AVE
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-2471
Country	:	US
Telephone Number	:	714-244-9134
Fax Number	:

Provider Business Practice Location Address
First Line	:	2019 N LAKE MEAD CIR
Second Line	:
City	:	ORANGE
State	:	CA
Zip	:	92867-2471
Country	:	US
Telephone Number	:	714-244-9134
Fax Number	:

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

Provider Enumeration Date	:	06/23/2014
Last Update Date	:	02/05/2015

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