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AMANDA ISABEL LICEA

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
PA-C

Contact information

Practice address
608 RADAM LN, AUSTIN, TX 78745-1172
(512) 443-5988
(512) 443-5055
Mailing address
8240 N MOPAC EXPY STE 100, AUSTIN, TX 78759-8869
(512) 687-1950
(512) 407-9010

Taxonomy

Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA08169
TX

Other

Enumeration date
11/15/2012
Last updated
09/22/2021
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