Healthcare Provider Details

I. General information

NPI: 1316862345
Provider Name (Legal Business Name): CHRISTY AMANDA NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2026
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 PARNASSUS AVE FL 4
SAN FRANCISCO CA
94143-2202
US

IV. Provider business mailing address

13451 GOLDMEDAL AVE
CHINO CA
91710-8355
US

V. Phone/Fax

Practice location:
  • Phone: 415-476-3883
  • Fax:
Mailing address:
  • Phone: 909-569-9098
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number95041044
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95173875
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number95041044
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number95041044
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: