Provider Demographics
NPI:1609818780
Name:GARNER, AMANDA JEAN (MD)
Entity Type:Individual
Prefix:DR
First Name:AMANDA
Middle Name:JEAN
Last Name:GARNER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5710 CRESCENT PARK E
Mailing Address - Street 2:#141
Mailing Address - City:PLAYA VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:90094-2063
Mailing Address - Country:US
Mailing Address - Phone:310-745-3704
Mailing Address - Fax:
Practice Address - Street 1:13652 CANTARA ST
Practice Address - Street 2:
Practice Address - City:PANORAMA CITY
Practice Address - State:CA
Practice Address - Zip Code:91402-5423
Practice Address - Country:US
Practice Address - Phone:818-375-2013
Practice Address - Fax:818-375-3802
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-12
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA79080207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A790800Medicaid
CAWA79080Medicare ID - Type Unspecified
CAI22323Medicare UPIN