Healthcare Provider Details

I. General information

NPI: 1821395740
Provider Name (Legal Business Name): AMANDA LYNN TOPIK NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2011
Last Update Date: 02/13/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR 8373
SAN DIEGO CA
92103-9001
US

IV. Provider business mailing address

200 WEST ARBOR DRIVE 8373
SAN DIEGO CA
92103-8373
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-7300
  • Fax: 616-543-7334
Mailing address:
  • Phone: 619-543-7300
  • Fax: 616-543-7334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number19049
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number3228
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: