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General NPI Number Information
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NPI Number | 1982854865
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Entity Type | Individual
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Provider Name | WENDY JESSICA AMEZCUA PA
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Gender | Female
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Dates
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Enumeration Date | 09/26/2008
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Last Update Date | 07/10/2013
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Provider Practice Location Address
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Address Line | 7798 CHERRY AVE
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City | FONTANA
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State | CA
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Zip | 92336-4014
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Country | US
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Telephone | 909-355-1296
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Fax | 909-355-1333
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Provider Business Mailing Address
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Address Line | 6743 WRANGLER RD
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City | CHINO HILLS
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State | CA
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Zip | 91709-3233
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Country | US
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Telephone | 714-747-5203
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 19888
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License Number State | CA
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