Basic Information
| Provider Information | |||||||||
| NPI: | 1225684251 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ARMENTA | ||||||||
| FirstName: | AMANDA | ||||||||
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| Credential: | LVN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 118 JULLIEN ST | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900633038 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3236377248 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1701 ZONAL AVE | ||||||||
| Address2: | |||||||||
| City: | LOS ANGELES | ||||||||
| State: | CA | ||||||||
| PostalCode: | 900331065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3232236298 | ||||||||
| FaxNumber: | 3232236399 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2019 | ||||||||
| LastUpdateDate: | 08/15/2019 | ||||||||
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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 | 164X00000X | 705594 | CA | Y | Nursing Service Providers | Licensed Vocational Nurse |
ID Information
| ID | Type | State | Issuer | Description | 705594 | 01 | CA | LVN NUMBER | OTHER |