Individual
MS. AMANDA RACHEL DE FOUR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
435 H ST, CV 31, CHULA VISTA, CA 91910-4307
(619) 691-7000
Mailing address
435 H ST, CV 31, CHULA VISTA, CA 91910-4307
(850) 712-1627
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
Primary
A118058
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
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Other
Enumeration date
04/07/2010
Last updated
07/01/2013
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