Provider Demographics
NPI:1568418150
Name:AMADOR, JOSE MAURO III (MD)
Entity Type:Individual
Prefix:DR
First Name:JOSE
Middle Name:MAURO
Last Name:AMADOR
Suffix:III
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1028
Mailing Address - Street 2:3567 MT. WHITNEY AVE.
Mailing Address - City:RIVERDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93656-1028
Mailing Address - Country:US
Mailing Address - Phone:559-867-7200
Mailing Address - Fax:559-867-0152
Practice Address - Street 1:3567 MT. WHITNEY AVE.
Practice Address - Street 2:
Practice Address - City:RIVERDALE
Practice Address - State:CA
Practice Address - Zip Code:93656-1028
Practice Address - Country:US
Practice Address - Phone:559-867-7200
Practice Address - Fax:559-867-0152
Is Sole Proprietor?:No
Enumeration Date:2006-05-25
Last Update Date:2014-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA83689207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A836890Medicaid
CAI11959Medicare UPIN