Basic Information
Provider Information
NPI: 1396213278
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: DESHAZER
FirstName: AMANDA
MiddleName: YVETTE
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 4 ROSSI CIR STE 141
Address2:  
City: SALINAS
State: CA
PostalCode: 939072358
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 4 ROSSI CIR STE 141
Address2:  
City: SALINAS
State: CA
PostalCode: 939072358
CountryCode: US
TelephoneNumber: 8314245565
FaxNumber:  
Other Information
ProviderEnumerationDate: 11/08/2018
LastUpdateDate: 11/08/2018
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
103K00000X  Y Behavioral Health & Social Service ProvidersBehavioral Analyst 

No ID Information.


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