Healthcare Provider Details

I. General information

NPI: 1346642212
Provider Name (Legal Business Name): AMANDA JOHNSON PHYSICIAN ASSISTANT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: AMANDA SCHRADERMEIER

II. Dates (important events)

Enumeration Date: 09/22/2014
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

518 GARDEN ST
SANTA BARBARA CA
93101-1696
US

IV. Provider business mailing address

518 GARDEN ST
SANTA BARBARA CA
93101-1696
US

V. Phone/Fax

Practice location:
  • Phone: 805-963-2445
  • Fax: 805-965-6981
Mailing address:
  • Phone: 805-963-2445
  • Fax: 805-965-6981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number1710296975
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA55230
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: