Provider Demographics
NPI:1013160571
Name:AMENTI, ADRIA JENNY (LAC)
Entity Type:Individual
Prefix:MS
First Name:ADRIA
Middle Name:JENNY
Last Name:AMENTI
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2018 CENTRAL AVE
Mailing Address - Street 2:APT A
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4232
Mailing Address - Country:US
Mailing Address - Phone:510-334-7816
Mailing Address - Fax:
Practice Address - Street 1:220 S CALIFORNIA AVE STE 100
Practice Address - Street 2:
Practice Address - City:PALO ALTO
Practice Address - State:CA
Practice Address - Zip Code:94306-1636
Practice Address - Country:US
Practice Address - Phone:650-470-0008
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-10-28
Last Update Date:2011-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC12557171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist