Healthcare Provider Details

I. General information

NPI: 1740593664
Provider Name (Legal Business Name): AMANDA A LLOYD M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/20/2010
Last Update Date: 09/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

477 N EL CAMINO REAL SUITE D304
ENCINITAS CA
92024-1328
US

IV. Provider business mailing address

PO BOX 1134
CARDIFF CA
92007-7134
US

V. Phone/Fax

Practice location:
  • Phone: 760-452-2080
  • Fax: 760-230-2927
Mailing address:
  • Phone: 760-452-2080
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number125.057761
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code207N00000X
TaxonomyDermatology Physician
License NumberA123852
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: