Provider Demographics
NPI:1245982511
Name:PERNUDI, AMANDA J (RDHAP)
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:J
Last Name:PERNUDI
Suffix:
Gender:F
Credentials:RDHAP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5502 COCHIN AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-5705
Mailing Address - Country:US
Mailing Address - Phone:626-203-8344
Mailing Address - Fax:
Practice Address - Street 1:5502 COCHIN AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-5705
Practice Address - Country:US
Practice Address - Phone:626-203-8344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-19
Last Update Date:2022-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA870124Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes124Q00000XDental ProvidersDental HygienistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CARDHAP870OtherRDHAP