Individual
AMANTHI CHANDRASENA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
901 OAK PARK BLVD STE 101, PISMO BEACH, CA 93449
(805) 481-2205
Mailing address
901 OAK PARK BLVD STE A, PISMO BEACH, CA 93449-3408
(805) 481-2205
(805) 481-2206
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A105736
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0-641-796-8
ECFMG NUMBER
CA
Enumeration date
10/15/2008
Last updated
11/02/2023
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