Healthcare Provider Details

I. General information

NPI: 1144779059
Provider Name (Legal Business Name): AMIANNE HUFFMAN P.A. - C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/04/2016
Last Update Date: 04/01/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8765 AERO DR STE 130
SAN DIEGO CA
92123-1767
US

IV. Provider business mailing address

7215 BEAGLE ST
SAN DIEGO CA
92111-4207
US

V. Phone/Fax

Practice location:
  • Phone: 858-541-0181
  • Fax: 858-430-0936
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number53496
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: