Individual
AMANDA MARIE ILAG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
AGNP
Contact information
Practice address
1901 4TH ST STE 201, BERKELEY, CA 94710-1986
(510) 929-1400
(510) 929-1414
Mailing address
PO BOX 511250, LOS ANGELES, CA 90051-7805
(510) 929-1400
(510) 929-1414
Taxonomy
Speciality
Code
Description
License number
State
363LP2300X
Primary Care Nurse Practitioner
Primary
95032119
CA
Other
Enumeration date
10/01/2024
Last updated
01/16/2025
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