Provider Demographics
NPI:1053002238
Name:MUTHANA, AMAL AHMED
Entity type:Individual
Prefix:
First Name:AMAL
Middle Name:AHMED
Last Name:MUTHANA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3103 SE LA VIDA CT
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93292-3994
Mailing Address - Country:US
Mailing Address - Phone:559-356-9113
Mailing Address - Fax:
Practice Address - Street 1:128 N AKERS ST STE C
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93291-5141
Practice Address - Country:US
Practice Address - Phone:559-385-2133
Practice Address - Fax:559-385-2134
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-17
Last Update Date:2023-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95025191363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner