Basic Information
| Provider Information | |||||||||
| NPI: | 1023182896 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMAR | ||||||||
| FirstName: | AIDA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 835 3RD AVENUE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 91911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194274661 | ||||||||
| FaxNumber: | 6194274661 | ||||||||
| Practice Location | |||||||||
| Address1: | 835 3RD AVE | ||||||||
| Address2: | SUITE C | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919111352 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6194274661 | ||||||||
| FaxNumber: | 6194274661 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/20/2006 | ||||||||
| LastUpdateDate: | 10/22/2008 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101Y00000X | Y | Behavioral Health & Social Service Providers | Counselor |
No ID Information.