Individual
MRS. AMANDA LOIS MACALLISTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
8265 W SUNSET BLVD STE 207, WEST HOLLYWOOD, CA 90046-2470
(323) 375-0950
Mailing address
1125 E 17TH ST., N152, SANTA ANA, CA 92701-2215
(714) 285-1100
(714) 285-1323
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA18521
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA18521
—
CA
Enumeration date
12/12/2006
Last updated
08/16/2020
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