Individual
AMANDA M IMAI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
2742 DOW AVE, TUSTIN, CA 92780-7242
(714) 665-1600
Mailing address
2742 DOW AVE, TUSTIN, CA 92780-7242
(714) 665-1600
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
18741
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18741
NURSE PRACTITIONER
CA
01
—
571054
CALIFORNIA REGISTERED NURSE
CA
Enumeration date
12/08/2009
Last updated
01/23/2014
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