Provider Demographics
NPI:1679242143
Name:ARMENDARIZ, AMANDA ALYSE
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:ALYSE
Last Name:ARMENDARIZ
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:ALYSE
Other - Last Name:SOTELO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11822 FLORAL DR
Mailing Address - Street 2:
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90601-2917
Mailing Address - Country:US
Mailing Address - Phone:562-908-4355
Mailing Address - Fax:
Practice Address - Street 1:11822 FLORAL DR
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90601-2917
Practice Address - Country:US
Practice Address - Phone:562-908-4355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-08
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant