Provider Demographics
NPI:1295022937
Name:FELIX, AMANDA LORRAINE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LORRAINE
Last Name:FELIX
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:AMANDA
Other - Middle Name:LORRAINE
Other - Last Name:FELIX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RDA
Mailing Address - Street 1:170 N CALVADOS AVE
Mailing Address - Street 2:
Mailing Address - City:AZUSA
Mailing Address - State:CA
Mailing Address - Zip Code:91702-3905
Mailing Address - Country:US
Mailing Address - Phone:626-625-5978
Mailing Address - Fax:
Practice Address - Street 1:170 N. CALVADOS AVE
Practice Address - Street 2:
Practice Address - City:AZUSA
Practice Address - State:CA
Practice Address - Zip Code:91702
Practice Address - Country:US
Practice Address - Phone:626-625-5978
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-01
Last Update Date:2011-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52290126800000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes126800000XDental ProvidersDental Assistant