Active NPI
Amanda Elizabeth Brodeur, DO
- Student in an Organized Health Care Education/Training Program
- Los Angeles, CA
National Provider Identifier
1780434936
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Student in an Organized Health Care Education/Training Program
- Practice address
- 1200 N State St
Clinic Tower, Suite A7D
Los Angeles, CA 90033 - Phone
- (323) 409-7053
- NPI assigned
- Mar 22, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | Primary |
Addresses
Primary practice location
1200 N State St
Clinic Tower, Suite A7D
Los Angeles, CA 90033
Mailing address
9707 Marby Grange Way
Bakersfield, CA 93312-5609
Phone (312) 659-6678
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in CA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20260109002585 | CA | Order and Referring Only - Emergency Medicine | 6800372772 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Osteopathy
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1711065600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1711065600000",
"number": "1780434936",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "9707 MARBY GRANGE WAY",
"city": "BAKERSFIELD",
"state": "CA",
"postal_code": "933125609",
"telephone_number": "312-659-6678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1200 N STATE ST",
"address_2": "CLINIC TOWER, SUITE A7D",
"city": "LOS ANGELES",
"state": "CA",
"postal_code": "90033",
"telephone_number": "323-409-7053"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BRODEUR",
"first_name": "AMANDA",
"middle_name": "ELIZABETH",
"credential": "DO",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-03-22",
"last_updated": "2024-03-22",
"certification_date": "2024-03-20",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Los Angeles, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.