Provider Demographics
NPI:1265006753
Name:AMADOR, NOEMI
Entity Type:Individual
Prefix:
First Name:NOEMI
Middle Name:
Last Name:AMADOR
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3068 N MOUNTAIN VIEW AVE
Mailing Address - Street 2:
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92405-2524
Mailing Address - Country:US
Mailing Address - Phone:909-494-0411
Mailing Address - Fax:
Practice Address - Street 1:3068 N MOUNTAIN VIEW AVE # 306
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92405-2524
Practice Address - Country:US
Practice Address - Phone:190-949-4041
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician