Basic Information
| Provider Information | |||||||||
| NPI: | 1528528163 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | LABORA | ||||||||
| FirstName: | AMANDA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 550 16TH STREET | ||||||||
| Address2: | 7TH FLOOR, BOX 0132 | ||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154765192 | ||||||||
| FaxNumber: | 4154761811 | ||||||||
| Practice Location | |||||||||
| Address1: | 550 16TH STREET | ||||||||
| Address2: | |||||||||
| City: | SAN FRANCISCO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94158 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4154765192 | ||||||||
| FaxNumber: | 4154761811 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/20/2019 | ||||||||
| LastUpdateDate: | 02/15/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 02/15/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 390200000X | Y | Student, Health Care | Student in an Organized Health Care Education/Training Program |
No ID Information.