Individual
AMANDA VASTAG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
222 W 39TH AVE, SAN MATEO, CA 94403
(650) 573-2222
Mailing address
222 W 39TH AVE, SAN MATEO, CA 94403-4364
Taxonomy
Speciality
Code
Description
License number
State
2084P0800X
Psychiatry Physician
036139917
IL
2084P0800X
Psychiatry Physician
Primary
155110
CA
Other
Enumeration date
06/21/2013
Last updated
09/25/2020
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