Healthcare Provider Details

I. General information

NPI: 1205519667
Provider Name (Legal Business Name): KATHRYN ROSE SPANGENBERG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2023
Last Update Date: 04/01/2026
Certification Date: 04/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

522 W CARSON ST
CARSON CA
90745-2635
US

IV. Provider business mailing address

4841 QUEEN FLORENCE LN
WOODLAND HILLS CA
91364-4747
US

V. Phone/Fax

Practice location:
  • Phone: 310-320-3400
  • Fax:
Mailing address:
  • Phone: 661-992-3709
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number67460
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: