Healthcare Provider Details

I. General information

NPI: 1447228796
Provider Name (Legal Business Name): AMANDA L CURNOCK MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/11/2006
Last Update Date: 02/24/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45280 SEELEY DR 3RD FLOOR
LA QUINTA CA
92253-6834
US

IV. Provider business mailing address

45280 SEELEY DR 3RD FLOOR
LA QUINTA CA
92253-6834
US

V. Phone/Fax

Practice location:
  • Phone: 760-610-7300
  • Fax: 760-610-7301
Mailing address:
  • Phone: 760-610-7300
  • Fax: 760-610-7301

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberC53711
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberC53711
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: