Individual
AMANDA VY-LYN FERGUSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
814 FRANCISCO ST, LOS ANGELES, CA 90017-2530
(909) 576-9050
Mailing address
1620 N ROOSEVELT AVE, PASADENA, CA 91104-1926
(909) 576-9050
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA56863
CA
Other
Enumeration date
06/12/2019
Last updated
06/12/2019
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