Provider Demographics
NPI:1457688699
Name:AMANFO, ARTHUR (PA-C)
Entity Type:Individual
Prefix:
First Name:ARTHUR
Middle Name:
Last Name:AMANFO
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1101 S NORTON AVE
Mailing Address - Street 2:APT 304
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-3352
Mailing Address - Country:US
Mailing Address - Phone:323-382-2767
Mailing Address - Fax:
Practice Address - Street 1:1173 N DIXIE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:SAN DIMAS
Practice Address - State:CA
Practice Address - Zip Code:91773-1200
Practice Address - Country:US
Practice Address - Phone:909-599-4422
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-09
Last Update Date:2009-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20657363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical