Provider Demographics
NPI:1780057232
Name:AMENTA, CARA (BA, CMT, BCTM)
Entity type:Individual
Prefix:
First Name:CARA
Middle Name:
Last Name:AMENTA
Suffix:
Gender:F
Credentials:BA, CMT, BCTM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 KELTON AVE APT 4
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90034-5542
Mailing Address - Country:US
Mailing Address - Phone:847-312-3909
Mailing Address - Fax:
Practice Address - Street 1:3500 KELTON AVE APT 4
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90034-5542
Practice Address - Country:US
Practice Address - Phone:847-312-3909
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA27404225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist