Provider Demographics
NPI:1316361074
Name:ALITORY, AMBER ROSE
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:ROSE
Last Name:ALITORY
Suffix:
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 1:8562 C AVE SPC 17
Mailing Address - Street 2:
Mailing Address - City:HESPERIA
Mailing Address - State:CA
Mailing Address - Zip Code:92345-5965
Mailing Address - Country:US
Mailing Address - Phone:760-912-9396
Mailing Address - Fax:
Practice Address - Street 1:8562 C AVE SPC 17
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-5965
Practice Address - Country:US
Practice Address - Phone:760-912-9396
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-14
Last Update Date:2024-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist