Individual
AMANDA BALLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
160 E ARTESIA ST STE 255, POMONA, CA 91767-2921
(909) 596-4346
(909) 596-4344
Mailing address
160 E ARTESIA ST STE 255, POMONA, CA 91767-2921
(909) 596-4346
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
58016
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
03/29/2019
Last updated
06/04/2020
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