1861091225 NPI number — AMBERLEE AMARAL RN

Table of content: AMBERLEE AMARAL RN (NPI 1861091225)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861091225 NPI number — AMBERLEE AMARAL RN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AMARAL
Provider First Name:
AMBERLEE
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861091225
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1758 DURHAM CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PLUMAS LAKE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
95961-9130
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
209-324-2801
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 TELEGRAPH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
OAKLAND
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94609-3239
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
800-607-6377
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/17/2020

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 163W00000X , with the licence number:  824742 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)