Provider Demographics
NPI:1376504902
Name:LITCHFIELD, AMY H (MD)
Entity Type:Individual
Prefix:DR
First Name:AMY
Middle Name:H
Last Name:LITCHFIELD
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:303 CALLE FRANCESCA
Mailing Address - Street 2:
Mailing Address - City:SAN CLEMENTE
Mailing Address - State:CA
Mailing Address - Zip Code:92672-4507
Mailing Address - Country:US
Mailing Address - Phone:949-294-1697
Mailing Address - Fax:
Practice Address - Street 1:28261 MARGUERITE PKWY
Practice Address - Street 2:SUITE 200
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92692-3703
Practice Address - Country:US
Practice Address - Phone:949-542-8500
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2015-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72814207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
G99763Medicare UPIN
CAWA72814BMedicare PIN