Individual
AMANDA ROACH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LVN
Contact information
Practice address
300 E 15TH ST, MERCED, CA 95341-6217
(209) 381-6800
Mailing address
300 E 15TH ST, MERCED, CA 95341-6217
(209) 381-6800
Taxonomy
Speciality
Code
Description
License number
State
164X00000X
Licensed Vocational Nurse
Primary
688152
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
688152
—
CA
Enumeration date
06/13/2017
Last updated
10/01/2020
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