Healthcare Provider Details

I. General information

NPI: 1508007238
Provider Name (Legal Business Name): WENDY MARIE RICHARDSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: WENDY MARIE STAFFORD PA-C

II. Dates (important events)

Enumeration Date: 03/09/2009
Last Update Date: 09/26/2026
Certification Date: 09/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13011 GATE DR
POWAY CA
92064-5841
US

IV. Provider business mailing address

13011 GATE DR
POWAY CA
92064-5841
US

V. Phone/Fax

Practice location:
  • Phone: 530-828-6794
  • Fax:
Mailing address:
  • Phone: 530-828-6794
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number20225
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: