Individual
ANGEL TIEN AMODO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6501 COYLE AVE, CARMICHAEL, CA 95608-0306
(916) 537-5365
Mailing address
705 ALICANTE DR, LODI, CA 95240-5608
(209) 993-9917
Taxonomy
Speciality
Code
Description
License number
State
167G00000X
Licensed Psychiatric Technician
Primary
36984
CA
Other
Enumeration date
08/10/2023
Last updated
07/14/2025
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