Individual
AMANDA QUYNH PHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11234 ANDERSON ST, LOMA LINDA, CA 92354-2804
(909) 558-4174
Mailing address
11234 ANDERSON ST, LOMA LINDA, CA 92354-2804
(909) 558-4174
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
TLL-2026-004
GU
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
04/03/2023
Last updated
02/16/2026
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