Provider Demographics
NPI:1316264930
Name:AMAYA, MYRNA ISABEL JR
Entity type:Individual
Prefix:
First Name:MYRNA
Middle Name:ISABEL
Last Name:AMAYA
Suffix:JR
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11318 ATLAS CT
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92883-1631
Mailing Address - Country:US
Mailing Address - Phone:626-253-8737
Mailing Address - Fax:
Practice Address - Street 1:11318 ATLAS CT
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92883-1631
Practice Address - Country:US
Practice Address - Phone:626-253-8737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-21
Last Update Date:2023-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374J00000XNursing Service Related ProvidersDoula
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health