Provider Demographics
NPI:1174377550
Name:WILKES, AMANDA TIFFANY
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:TIFFANY
Last Name:WILKES
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 1:16 FORD RD APT D
Mailing Address - Street 2:
Mailing Address - City:CARMEL VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93924-9513
Mailing Address - Country:US
Mailing Address - Phone:831-869-5941
Mailing Address - Fax:
Practice Address - Street 1:339 PAJARO ST
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-3400
Practice Address - Country:US
Practice Address - Phone:831-800-7530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-12
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program