Provider Demographics
NPI:1063098655
Name:STEPHENS, AMANDA ALMANZA (EMT)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:ALMANZA
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:EMT
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:
Other - Last Name:ALMANZA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:EMT
Mailing Address - Street 1:1069 PINEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:SANGER
Mailing Address - State:CA
Mailing Address - Zip Code:93657-8757
Mailing Address - Country:US
Mailing Address - Phone:559-213-3410
Mailing Address - Fax:
Practice Address - Street 1:2960 S CHERRY AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93706-5445
Practice Address - Country:US
Practice Address - Phone:559-213-3410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-23
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB06-7842146N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146N00000XEmergency Medical Service ProvidersEmergency Medical Technician, Basic