Healthcare Provider Details

I. General information

NPI: 1366366825
Provider Name (Legal Business Name): ERICA LANE MAGGELET PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/07/2026
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1221 N SALSIPUEDES ST # A
SANTA BARBARA CA
93103-2327
US

IV. Provider business mailing address

4 E DARTMOOR LN
SLC UT
84103-2279
US

V. Phone/Fax

Practice location:
  • Phone: 801-554-1073
  • Fax:
Mailing address:
  • Phone: 801-554-1073
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA68759
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: