Individual
AMELIA VONGPHAIROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
891 MOUNTAIN RANCH RD, SAN ANDREAS, CA 95249-9713
(209) 754-6464
Mailing address
2239 WILLOW CREEK RD, SAN ANDREAS, CA 95249-9789
(209) 890-5567
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
136249
CA
Other
Enumeration date
12/15/2023
Last updated
12/30/2025
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