Provider Demographics
NPI:1386324267
Name:AMYGDALA MEDICAL CORPORATION
Entity type:Organization
Organization Name:AMYGDALA MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:TAQIALDEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:ZAMIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-712-0711
Mailing Address - Street 1:1310 W STEWART DR STE 301
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-3838
Mailing Address - Country:US
Mailing Address - Phone:714-712-0711
Mailing Address - Fax:657-224-4781
Practice Address - Street 1:1310 W STEWART DR STE 301
Practice Address - Street 2:
Practice Address - City:ORANGE
Practice Address - State:CA
Practice Address - Zip Code:92868-3838
Practice Address - Country:US
Practice Address - Phone:714-712-0711
Practice Address - Fax:657-224-4781
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty