Individual
MISS AMY SUPERNAW
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
4575 COLLEGE AVE, SAN DIEGO, CA 92115-4011
(888) 743-7526
Mailing address
1075 CAMINO DEL RIO S, SAN DIEGO, CA 92108-3538
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
53038
CA
Other
Enumeration date
11/24/2015
Last updated
11/24/2015
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