Healthcare Provider Details

I. General information

NPI: 1669851481
Provider Name (Legal Business Name): AMANDA KAY PHILLIPS RN, CPN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: AMANDA KAY PHILLIPS

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 05/26/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4667 RANCHVIEW CIR
HUNTINGTON BEACH CA
92649-3862
US

IV. Provider business mailing address

4667 RANCHVIEW CIR
HUNTINGTON BEACH CA
92649-3862
US

V. Phone/Fax

Practice location:
  • Phone: 951-490-7276
  • Fax:
Mailing address:
  • Phone: 951-490-7276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number706654
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: