MEDICARE: MRS. ANASTACIA KAY AMIN PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AS0400X	Surgical Physician Assistant	19329	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1255314928
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ANASTACIA KAY AMIN PA-C

Provider Business Mailing Address
First Line	:	3000 Q ST
Second Line	:	DEPT OF UROLOGY
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-7058
Country	:	US
Telephone Number	:	916-733-3310
Fax Number	:	916-733-5378

Provider Business Practice Location Address
First Line	:	3000 Q ST
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95816-7058
Country	:	US
Telephone Number	:	916-733-3310
Fax Number	:	916-733-5378

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/27/2005
Last Update Date	:	01/11/2022

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