Healthcare Provider Details

I. General information

NPI: 1649545336
Provider Name (Legal Business Name): AMANDA DUTTON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/14/2012
Last Update Date: 03/10/2025
Certification Date: 03/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 W PUEBLO ST
SANTA BARBARA CA
93105-4365
US

IV. Provider business mailing address

317 W PUEBLO ST
SANTA BARBARA CA
93105-4365
US

V. Phone/Fax

Practice location:
  • Phone: 805-898-3138
  • Fax: 805-898-3416
Mailing address:
  • Phone: 805-898-3138
  • Fax: 805-898-3416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA61736
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: