Provider Demographics
NPI:1982137212
Name:JAMAL, AMANDA L
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:L
Last Name:JAMAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:260 W COURT ST
Mailing Address - Street 2:APT 26
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-2562
Mailing Address - Country:US
Mailing Address - Phone:916-209-0401
Mailing Address - Fax:
Practice Address - Street 1:401 PARADISE RD
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95351-3163
Practice Address - Country:US
Practice Address - Phone:209-558-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-04
Last Update Date:2021-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA159540207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine