Individual
AMY MY LY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
552 W FOOTHILL BLVD # 100, GLENDORA, CA 91741-2470
(626) 335-4079
Mailing address
PO BOX 35380, LAS VEGAS, NV 89133-5380
(702) 579-3203
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
—
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
03/23/2020
Last updated
01/13/2026
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