Individual
AMANDA MANSOOREH DADASHI
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
13768 ROSWELL AVE, CHINO, CA 91710-1401
(909) 614-9221
Mailing address
PO BOX 2754, CHINO HILLS, CA 91709-0092
(909) 614-9221
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
F09191959
CA
Other
Enumeration date
01/27/2020
Last updated
04/09/2021
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