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Provider Information for 1225481203

Please Note: Issuance of an NPI does not ensure or validate that the Health Care Provider is Licensed or Credentialed. For more information please refer to NPI: What You Need to Know

AMANDA R. GOMEZ

Other Name:   AMANDA FLORES
Gender: FEMALE

Individual NPI: 1225481203

Calendar   Last Updated:  2016-07-14
  Certification Date: 

Details

Name Value
NPI 1225481203
Enumeration Date 2016-07-14
NPI Type 1 - Individual
Sole Proprietor NO
Status Active
Mailing Address 17060 MAIN ST
LA PUENTE, CA 91744-5018
United States

Phone: | Fax:
View Map External Link
Primary Practice Address 160 S 7TH AVE
LA PUENTE, CA 91746-3211
United States

Phone: 626-961-8971 | Fax:
View Map External Link
Health Information Exchange
Endpoint Type Endpoint Endpoint Description Use Content Type Affiliation Endpoint Location
Other Identifiers
Issuer State Number
Taxonomy
Primary Taxonomy Selected Taxonomy State License Number
Yes 171M00000X - Case Manager/Care Coordinator