Individual
AMANDA MALLIAROS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2452 WILSHIRE ST, RIVERSIDE, CA 92501-2144
(951) 682-6631
Mailing address
2452 WILSHIRE ST, RIVERSIDE, CA 92501-2144
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
VN288268
CA
Other
Enumeration date
11/12/2018
Last updated
11/12/2018
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