Provider Demographics
NPI:1609530666
Name:ISSA, AMIRA E (PC, BA)
Entity Type:Individual
Prefix:MS
First Name:AMIRA
Middle Name:E
Last Name:ISSA
Suffix:
Gender:F
Credentials:PC, BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:889 MURRAY AVE
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93405-1736
Mailing Address - Country:US
Mailing Address - Phone:805-456-2333
Mailing Address - Fax:
Practice Address - Street 1:889 MURRAY AVE
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93405-1736
Practice Address - Country:US
Practice Address - Phone:805-456-2333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-26
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106E00000XBehavioral Health & Social Service ProvidersAssistant Behavior Analyst