Provider Demographics
NPI:1770334534
Name:AMANI, ATUSA (LAC)
Entity type:Individual
Prefix:
First Name:ATUSA
Middle Name:
Last Name:AMANI
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 1:4314 MARINA CITY DR UNIT 130
Mailing Address - Street 2:
Mailing Address - City:MARINA DEL REY
Mailing Address - State:CA
Mailing Address - Zip Code:90292-5814
Mailing Address - Country:US
Mailing Address - Phone:818-940-6910
Mailing Address - Fax:
Practice Address - Street 1:4314 MARINA CITY DR UNIT 130
Practice Address - Street 2:
Practice Address - City:MARINA DEL REY
Practice Address - State:CA
Practice Address - Zip Code:90292-5814
Practice Address - Country:US
Practice Address - Phone:818-940-6910
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-29
Last Update Date:2024-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20050171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist