Healthcare Provider Details

I. General information

NPI: 1629084447
Provider Name (Legal Business Name): AMY LANTIS STEMERMAN MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMY RACHELLE LANTIS MD

II. Dates (important events)

Enumeration Date: 08/01/2006
Last Update Date: 12/17/2020
Certification Date: 12/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

559 ABBOTT ST
SALINAS CA
93901-4325
US

IV. Provider business mailing address

PO BOX 190
SIMI VALLEY CA
93062-0190
US

V. Phone/Fax

Practice location:
  • Phone: 831-796-3740
  • Fax:
Mailing address:
  • Phone: 805-577-2021
  • Fax: 805-577-2018

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberL7352
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License NumberA99993
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: