Provider Demographics
NPI:1457012841
Name:GHARBAWI, AMANDA (LAC)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:GHARBAWI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:730 JAMES ST
Mailing Address - Street 2:
Mailing Address - City:LONGMONT
Mailing Address - State:CO
Mailing Address - Zip Code:80501-6443
Mailing Address - Country:US
Mailing Address - Phone:720-980-8480
Mailing Address - Fax:
Practice Address - Street 1:16 MOUNTAIN VIEW AVE STE 111B
Practice Address - Street 2:
Practice Address - City:LONGMONT
Practice Address - State:CO
Practice Address - Zip Code:80501-3420
Practice Address - Country:US
Practice Address - Phone:720-980-8480
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-07
Last Update Date:2022-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist