Provider Demographics
NPI:1588385942
Name:CARNEIRO, AMANDA
Entity type:Individual
Prefix:MISS
First Name:AMANDA
Middle Name:
Last Name:CARNEIRO
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 1:4470 W. SUNSET BLVD
Mailing Address - Street 2:SUITE 107, PMB 95606
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027
Mailing Address - Country:US
Mailing Address - Phone:718-864-8700
Mailing Address - Fax:
Practice Address - Street 1:4958 FOUNTAIN AVE
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90029-1535
Practice Address - Country:US
Practice Address - Phone:718-864-8700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133N00000XDietary & Nutritional Service ProvidersNutritionist