Provider Demographics
NPI:1245777325
Name:MCGOVNEY, AMBER (CSCM, MA)
Entity Type:Individual
Prefix:
First Name:AMBER
Middle Name:
Last Name:MCGOVNEY
Suffix:
Gender:F
Credentials:CSCM, MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5815 E LA PALMA AVE SPC 130
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92807-2236
Mailing Address - Country:US
Mailing Address - Phone:714-287-8724
Mailing Address - Fax:714-333-4490
Practice Address - Street 1:5815 E LA PALMA AVE SPC 130
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92807-2236
Practice Address - Country:US
Practice Address - Phone:714-287-8724
Practice Address - Fax:714-333-4490
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-26
Last Update Date:2017-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA304700187253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care