Healthcare Provider Details

I. General information

NPI: 1447856869
Provider Name (Legal Business Name): ADRIANNE SOSEFINA AMITUANAI PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2020
Last Update Date: 12/14/2023
Certification Date: 12/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 MDG/SGXP 101 BODIN CIRCLE
TRAVIS AIR FORCE BASE CA
94535-1809
US

IV. Provider business mailing address

60 MDG/SGXP 101 BODIN CIRCLE
TRAVIS AIR FORCE BASE CA
94535-1809
US

V. Phone/Fax

Practice location:
  • Phone: 707-423-3909
  • Fax:
Mailing address:
  • Phone: 707-423-3909
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: