Provider Demographics
NPI:1720632045
Name:VANDERFORD, AMANDA M (CP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:M
Last Name:VANDERFORD
Suffix:
Gender:F
Credentials:CP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800 YANKEE JIMS RD
Mailing Address - Street 2:
Mailing Address - City:FORESTHILL
Mailing Address - State:CA
Mailing Address - Zip Code:95631-9408
Mailing Address - Country:US
Mailing Address - Phone:530-401-4353
Mailing Address - Fax:
Practice Address - Street 1:6150 TULE LANE
Practice Address - Street 2:
Practice Address - City:FORESTHILL
Practice Address - State:CA
Practice Address - Zip Code:95631
Practice Address - Country:US
Practice Address - Phone:530-367-2609
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-25
Last Update Date:2019-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Single Specialty