Provider Demographics
NPI:1073307179
Name:MATTHEWS, AMANDA (CBD)
Entity type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:MATTHEWS
Suffix:
Gender:
Credentials:CBD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23565 CUTTER DR
Mailing Address - Street 2:
Mailing Address - City:CANYON LAKE
Mailing Address - State:CA
Mailing Address - Zip Code:92587-7423
Mailing Address - Country:US
Mailing Address - Phone:951-457-2414
Mailing Address - Fax:
Practice Address - Street 1:23565 CUTTER DR
Practice Address - Street 2:
Practice Address - City:CANYON LAKE
Practice Address - State:CA
Practice Address - Zip Code:92587-7423
Practice Address - Country:US
Practice Address - Phone:951-457-2414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-04-05
Last Update Date:2025-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA374J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula