Individual
AMANDA DUBEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
18111 NORDHOFF ST, NORTHRIDGE, CA 91330-0001
(818) 677-1200
Mailing address
25519 CLEMENS CT, STEVENSON RANCH, CA 91381-1526
(661) 993-3147
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
22
RESPIRATORY, DEVELOPMENTAL, REHABILITATIVE AND RESTORATIVE SERVICE PROVIDER
CA
Enumeration date
05/22/2019
Last updated
09/02/2021
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