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NPI Code Detail

MEDICARE: AMANDA SEVILLA RD

MEDICARE: AMANDA SEVILLA RD
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
1133V00000XRegistered Dietitian86108221CA

General Provider Information

NPI Number : 1922616259
Entity Type Code : Individual
Provider Name (Legal Business Name) : AMANDA SEVILLA RD
Provider Business Mailing Address
First Line : 2474 CANYON TERRACE DR
Second Line :
City : CHINO HILLS
State : CA
Zip : 91709-4403
Country : US
Telephone Number : 909-538-5172
Fax Number :
Provider Business Practice Location Address
First Line : 2474 CANYON TERRACE DR
Second Line :
City : CHINO HILLS
State : CA
Zip : 91709-4403
Country : US
Telephone Number : 909-538-5172
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2020
Last Update Date : 07/22/2020

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Directions to “ AMANDA SEVILLA RD” Practice Location

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