Basic Information
| Provider Information | |||||||||
| NPI: | 1184766974 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | AMADOR | ||||||||
| FirstName: | CARLOS | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 WHITTIER BLVD | ||||||||
| Address2: | SUITE 3025 | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900231307 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316392500 | ||||||||
| FaxNumber: | 2133652813 | ||||||||
| Practice Location | |||||||||
| Address1: | 2500 WILSHIRE BLVD | ||||||||
| Address2: | S | ||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900574303 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2316392500 | ||||||||
| FaxNumber: | 2133652813 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2007 | ||||||||
| LastUpdateDate: | 02/25/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 164X00000X | VN216407 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
ID Information
| ID | Type | State | Issuer | Description | VN216407 | 01 | CA | LVN | OTHER |