Healthcare Provider Details

I. General information

NPI: 1487344321
Provider Name (Legal Business Name): ASHLEY NICOLE PETERMAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ASHLEY NICOLE DEUTSCH PA-C

II. Dates (important events)

Enumeration Date: 05/12/2023
Last Update Date: 11/26/2025
Certification Date: 11/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4950 BARRANCA PKWY STE 103
IRVINE CA
92604-4630
US

IV. Provider business mailing address

PO BOX 2218
SUISUN CITY CA
94585-5218
US

V. Phone/Fax

Practice location:
  • Phone: 949-552-2700
  • Fax: 949-552-2701
Mailing address:
  • Phone: 657-241-3600
  • Fax: 657-241-7708

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA62726
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: