Individual
AMANDA COLLINS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1625 SCHRADER BLVD, LOS ANGELES, CA 90028-6213
(323) 860-3716
Mailing address
1625 SCHRADER BLVD, LOS ANGELES, CA 90028-6213
(323) 860-3716
Taxonomy
Speciality
Code
Description
License number
State
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
01536011
MEDICAL
—
Enumeration date
10/05/2023
Last updated
10/05/2023
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