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General NPI Number Information
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NPI Number | 1184345597
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Entity Type | Individual
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Provider Name | AMANDA FRAKES
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Gender | Female
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Dates
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Enumeration Date | 09/06/2022
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Last Update Date | 09/06/2022
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Provider Practice Location Address
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Address Line | 510 S 2ND AVE
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City | COVINA
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State | CA
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Zip | 91723-3017
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Country | US
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Telephone | 626-974-8123
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Fax | 626-974-8198
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Provider Business Mailing Address
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Address Line | 8279 JADEITE AVE
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-3521
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Country | US
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Telephone | 909-730-6028
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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