Provider Demographics
NPI:1144328568
Name:BANDY, AMY T (DO)
Entity type:Individual
Prefix:DR
First Name:AMY
Middle Name:T
Last Name:BANDY
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:320 SUPERIOR AVE STE 170
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92663-6139
Mailing Address - Country:US
Mailing Address - Phone:949-574-0574
Mailing Address - Fax:949-574-0573
Practice Address - Street 1:320 SUPERIOR AVE STE 170
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-6139
Practice Address - Country:US
Practice Address - Phone:949-574-0574
Practice Address - Fax:949-574-0573
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2010-07-28
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Provider Licenses
StateLicense IDTaxonomies
CA20A5862208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMDN 108649-1OtherWORKMANS COMP
CAF34962Medicare UPIN