Provider Demographics
NPI:1093757106
Name:AMADOR, MAURO MALACON (PHD)
Entity Type:Individual
Prefix:DR
First Name:MAURO
Middle Name:MALACON
Last Name:AMADOR
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:32 E ALISAL ST
Mailing Address - Street 2:SUITE 212
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-3404
Mailing Address - Country:US
Mailing Address - Phone:831-754-2551
Mailing Address - Fax:
Practice Address - Street 1:32 E ALISAL ST
Practice Address - Street 2:SUITE 212
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3404
Practice Address - Country:US
Practice Address - Phone:831-754-2551
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY8624103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical