Individual
AMANDA PACIFICO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
23965 SARAVILLA DR APT 3, CLINTON TOWNSHIP, MI 48035-3188
(586) 339-4269
Mailing address
23965 SARAVILLA DR APT 3, CLINTON TOWNSHIP, MI 48035-3188
(586) 339-4269
Taxonomy
Speciality
Code
Description
License number
State
302R00000X
Health Maintenance Organization
Primary
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/04/2014
Last updated
11/04/2014
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