Provider Demographics
NPI:1871125385
Name:FREAD, AMELIA BARNES (LAC)
Entity type:Individual
Prefix:
First Name:AMELIA
Middle Name:BARNES
Last Name:FREAD
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:AMELIA
Other - Middle Name:FREAD
Other - Last Name:JULY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2820 LA LOMA DR APT 20
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-3363
Mailing Address - Country:US
Mailing Address - Phone:505-236-3500
Mailing Address - Fax:
Practice Address - Street 1:2820 LA LOMA DR APT 20
Practice Address - Street 2:
Practice Address - City:RANCHO CORDOVA
Practice Address - State:CA
Practice Address - Zip Code:95670-3363
Practice Address - Country:US
Practice Address - Phone:505-236-3500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-12
Last Update Date:2024-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15185171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist