Healthcare Provider Details

I. General information

NPI: 1164880811
Provider Name (Legal Business Name): ANDREA KREMSREITER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2016
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2040 VIBORG RD STE 140
SOLVANG CA
93463
US

IV. Provider business mailing address

PO BOX 62106
SANTA BARBARA CA
93160-2106
US

V. Phone/Fax

Practice location:
  • Phone: 805-686-5370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA55833
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number3937-23
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: