Healthcare Provider Details

I. General information

NPI: 1588970537
Provider Name (Legal Business Name): AMY E. NETERER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2010
Last Update Date: 12/11/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27472 PORTOLA PKWY SUITE 205-#151
FOOTHILL RANCH CA
92610-2853
US

IV. Provider business mailing address

27472 PORTOLA PKWY #205-#151
FOOTHILL RANCH CA
92610-2853
US

V. Phone/Fax

Practice location:
  • Phone: 949-455-4920
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA21129
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: