MEDICARE: AMALI

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	2084P0804X	Child & Adolescent Psychiatry Physician

General Provider Information

NPI Number	:	1679392070
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AMALI

Provider Business Mailing Address
First Line	:	826 ORANGE AVENUE
Second Line	:	PMB 508
City	:	CORONADO
State	:	CA
Zip	:	92118
Country	:	US
Telephone Number	:	619-837-2072
Fax Number	:

Provider Business Practice Location Address
First Line	:	432 HOTZ ST
Second Line	:
City	:	SPRING VALLEY
State	:	CA
Zip	:	91977-5709
Country	:	US
Telephone Number	:	619-837-2072
Fax Number	:

Authorized Official
Title or Position	:	CEO & GENERAL COUNSEL
Name	:	AMEL ESPOSITO
Credential	:	J.D.
Telephone Number	:	619-837-2072

Provider Enumeration Date	:	10/03/2024
Last Update Date	:	10/29/2024

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