Healthcare Provider Details

I. General information

NPI: 1083845887
Provider Name (Legal Business Name): STACEY AMBER GERBRANDT PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 08/11/2020
Certification Date: 08/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27879 SMYTH DR
VALENCIA CA
91355-4011
US

IV. Provider business mailing address

27879 SMYTH DR
VALENCIA CA
91355-4011
US

V. Phone/Fax

Practice location:
  • Phone: 661-259-2500
  • Fax:
Mailing address:
  • Phone: 661-259-2500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA20424
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number20424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: