Provider Demographics
NPI:1982854865
Name:AMEZCUA, WENDY JESSICA (PA)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:JESSICA
Last Name:AMEZCUA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:WENDY
Other - Middle Name:JESSICA
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:6743 WRANGLER RD
Mailing Address - Street 2:
Mailing Address - City:CHINO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91709-3233
Mailing Address - Country:US
Mailing Address - Phone:714-747-5203
Mailing Address - Fax:
Practice Address - Street 1:7798 CHERRY AVE
Practice Address - Street 2:
Practice Address - City:FONTANA
Practice Address - State:CA
Practice Address - Zip Code:92336-4014
Practice Address - Country:US
Practice Address - Phone:909-355-1296
Practice Address - Fax:909-355-1333
Is Sole Proprietor?:No
Enumeration Date:2008-09-26
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA19888363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical