Provider Demographics
NPI:1770256778
Name:AMATO, NANCY
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:
Last Name:AMATO
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 1:624 24TH ST
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-2206
Mailing Address - Country:US
Mailing Address - Phone:310-600-8225
Mailing Address - Fax:
Practice Address - Street 1:624 24TH ST
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-2206
Practice Address - Country:US
Practice Address - Phone:310-600-8225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date: