Basic Information
| Provider Information | |||||||||
| NPI: | 1518692383 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | AMAYA | ||||||||
| FirstName: | HUGO | ||||||||
| MiddleName: | ALBERT | ||||||||
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| Credential: | SUDRC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1035 W PERALTA WAY | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937054930 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4089816527 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4705 N SONORA AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937223966 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5592767558 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/17/2022 | ||||||||
| LastUpdateDate: | 07/17/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 07/14/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 11712 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) |
No ID Information.