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General NPI Number Information
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NPI Number | 1770056566
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Entity Type | Individual
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Provider Name | JUSTIN PETER SPANGLER PA
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Gender | Male
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Dates
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Enumeration Date | 01/04/2019
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Last Update Date | 05/27/2025
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Provider Practice Location Address
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Address Line | 2700 DOLBEER ST
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City | EUREKA
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State | CA
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Zip | 95501-4736
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Country | US
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Telephone | 707-269-4253
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Fax |
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Provider Business Mailing Address
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Address Line | 2160 REED AVE
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City | SAN DIEGO
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State | CA
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Zip | 92109-5557
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Country | US
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Telephone | 805-427-5699
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 56456
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2082
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License Number State | NV
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 025290
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License Number State | NY
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Taxonomy #4
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 7975
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License Number State | AZ
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