Healthcare Provider Details

I. General information

NPI: 1669780722
Provider Name (Legal Business Name): ANGELA FISHER-WEAVER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/22/2010
Last Update Date: 10/17/2025
Certification Date: 10/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

35591 E KINGS CANYON RD STE B
SQUAW VALLEY CA
93675-9651
US

IV. Provider business mailing address

35591 E KINGS CANYON RD STE B
SQUAW VALLEY CA
93675-9651
US

V. Phone/Fax

Practice location:
  • Phone: 559-903-7221
  • Fax: 559-557-4596
Mailing address:
  • Phone: 559-903-7221
  • Fax: 559-557-4596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA-1513
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number14191875-1206
License Number StateUT
# 3
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA-918
License Number StateWY
# 4
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21144
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: