Healthcare Provider Details

I. General information

NPI: 1114834108
Provider Name (Legal Business Name): AMANDA LY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/25/2026
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7830 CLAIREMONT MESA BLVD STE 100
SAN DIEGO CA
92111-1632
US

IV. Provider business mailing address

7830 CLAIREMONT MESA BLVD STE 100
SAN DIEGO CA
92111-1632
US

V. Phone/Fax

Practice location:
  • Phone: 619-229-2999
  • Fax:
Mailing address:
  • Phone: 619-229-2999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: