Healthcare Provider Details

I. General information

NPI: 1710386057
Provider Name (Legal Business Name): JOHANNA ROOIJAKKERS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2014
Last Update Date: 07/20/2020
Certification Date: 07/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 E CARRILLO ST
SANTA BARBARA CA
93101-1460
US

IV. Provider business mailing address

7028 SW LORNA TER
BEAVERTON OR
97007-5812
US

V. Phone/Fax

Practice location:
  • Phone: 805-563-3307
  • Fax: 805-563-0998
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: