Healthcare Provider Details

I. General information

NPI: 1962926006
Provider Name (Legal Business Name): AMANDA DEARINGER MS, PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 03/02/2023
Certification Date: 03/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

801 E KATELLA AVE
ANAHEIM CA
92805-6614
US

IV. Provider business mailing address

830 VENETO
IRVINE CA
92614-5963
US

V. Phone/Fax

Practice location:
  • Phone: 714-633-6373
  • Fax:
Mailing address:
  • Phone: 760-703-8265
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: