Individual
AMANDA MARIE STALEY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
11175 CAMPUS ST STE 11120, LOMA LINDA, CA 92350-1700
(909) 558-8291
Mailing address
11175 CAMPUS ST STE 11120, LOMA LINDA, CA 92350-1700
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
95011691
CA
Other
Enumeration date
11/25/2019
Last updated
11/25/2019
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