Provider Demographics
NPI:1740613652
Name:AMANCHA, ALEXANDRA ELIZABETH
Entity Type:Individual
Prefix:
First Name:ALEXANDRA
Middle Name:ELIZABETH
Last Name:AMANCHA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:711 W CAMINO REAL AVE
Mailing Address - Street 2:SUITE 202
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-9325
Mailing Address - Country:US
Mailing Address - Phone:626-574-0437
Mailing Address - Fax:626-574-2902
Practice Address - Street 1:711 W CAMINO REAL AVE
Practice Address - Street 2:SUITE 202
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-9325
Practice Address - Country:US
Practice Address - Phone:626-574-0437
Practice Address - Fax:626-574-2902
Is Sole Proprietor?:No
Enumeration Date:2013-08-14
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA 7665237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist