Provider Demographics
NPI:1366904575
Name:THORSON, AMANDA HANNAH (DO)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:HANNAH
Last Name:THORSON
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:HANNAH
Other - Last Name:POPISH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:1941 JOHNSON AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:SAN LUIS OBISPO
Mailing Address - State:CA
Mailing Address - Zip Code:93401-4175
Mailing Address - Country:US
Mailing Address - Phone:805-789-4111
Mailing Address - Fax:805-543-6357
Practice Address - Street 1:1941 JOHNSON AVE STE 301
Practice Address - Street 2:
Practice Address - City:SAN LUIS OBISPO
Practice Address - State:CA
Practice Address - Zip Code:93401-4175
Practice Address - Country:US
Practice Address - Phone:805-786-4111
Practice Address - Fax:805-543-6357
Is Sole Proprietor?:No
Enumeration Date:2019-04-05
Last Update Date:2024-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21016207V00000X, 207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology