Healthcare Provider Details

I. General information

NPI: 1013602960
Provider Name (Legal Business Name): AMANDA KHALIL MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/06/2023
Last Update Date: 02/05/2026
Certification Date: 02/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1686 BARTON RD
REDLANDS CA
92373-1488
US

IV. Provider business mailing address

1686 BARTON RD
REDLANDS CA
92373-1488
US

V. Phone/Fax

Practice location:
  • Phone: 909-558-9532
  • Fax:
Mailing address:
  • Phone: 909-558-9532
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberA202090
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: