Individual
AMANDA MARIE RICHARDSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
306 N BASILIO AVE, SAN DIMAS, CA 91773-2707
(909) 754-0280
Mailing address
306 N BASILIO AVE, SAN DIMAS, CA 91773-2707
(909) 754-0280
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
55953
CA
Other
Enumeration date
05/15/2018
Last updated
06/29/2022
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