Fadela Amine

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

95028129 Issued in CA

Practice address

17872 Gillette Ave Ste 240
Irvine, CA 92614-6573

Phone

(949) 529-2041

NPI assigned

May 25, 2022

Last updated

Nov 23, 2023By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 3

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Body Details Management, LLC

  • Medical Specialty Clinic/Center
  • Boca Raton, FL
  • NPI 1902263817
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1653436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1700697600000",
    "number": "1548908866",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12612 CHALLENGER PKWY STE 365",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328262784"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "17872 GILLETTE AVE STE 240",
            "city": "IRVINE",
            "state": "CA",
            "postal_code": "926146573",
            "telephone_number": "949-529-2041"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "AMINE",
        "first_name": "FADELA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2022-05-25",
        "last_updated": "2023-11-23",
        "certification_date": "2023-11-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "CA",
            "license": "95028129",
            "primary": true
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "FL",
            "license": "APRN11020947",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "ID",
            "license": "75661",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• American Fertility Medical Center Corporation
• American Medical Technologies Inc
• Americare Respiratory Services, Inc.
• Justin Amigo, MS
• Priyal Ronak Amin
• Amini Dental Corporation (Aminidentalcorp)
• Aram Amini Nejad, PSY.D.
• Fariba Amini, PT
• Mohammad John Amini, DDS
• Sanam Amini, OTR/L

• Nurse Practitioner in Irvine, CA
• Providers in Irvine, CA by specialty
• Nurse Practitioner in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 23, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.