Provider Demographics
NPI:1760772321
Name:AMADOR, JUSTIN MICHAEL-ALLEN (FNP)
Entity type:Individual
Prefix:
First Name:JUSTIN
Middle Name:MICHAEL-ALLEN
Last Name:AMADOR
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:JUSTIN
Other - Middle Name:MICHAEL
Other - Last Name:ALLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:808 W 58TH ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90037-3632
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:808 W 58TH ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90037-3632
Practice Address - Country:US
Practice Address - Phone:323-541-1600
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK207265363LF0000X
OR202204598NP-PP363LF0000X
WAAP61379785363LF0000X
NV853522363LF0000X
NY356085363LF0000X
CA95004179363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY356085OtherNP LICENSE NUMBER
AK207265OtherNP LICENSE NUMBER
WAAP61379785OtherNP LICENSE NUMBER
CA95004179OtherNP LICENSE NUMBER
OR202204598NP-PPOtherNP LICENSE NUMBER
NV853522OtherNP LICENSE NUMBER