Individual
AMANDA GONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
2857 LINCOLN AVE, CLOVIS, CA 93611
(559) 325-6518
Mailing address
2857 LINCOLN AVE, CLOVIS, CA 93611
(559) 325-6518
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN214738
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
EPS014610
CALIFORNIA MEDICAID
CA
01
—
RVN002950
PROGRAM
CA
Enumeration date
01/26/2007
Last updated
07/08/2007
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