Healthcare Provider Details

I. General information

NPI: 1366376709
Provider Name (Legal Business Name): AMANDA CRYSTAL AVALOS DNP
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 DUARTE RD
DUARTE CA
91010-3012
US

IV. Provider business mailing address

14177 MOUNTAIN AVE
CHINO CA
91710-1135
US

V. Phone/Fax

Practice location:
  • Phone: 626-664-8632
  • Fax:
Mailing address:
  • Phone: 626-664-8632
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number95039820
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: