MEDICARE: MRS. ASHLEY PATTESON ATLAS 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	363A00000X	Physician Assistant	PA23304	CA

General Provider Information

NPI Number	:	1861787301
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ASHLEY PATTESON ATLAS PA-C

Provider Business Mailing Address
First Line	:	1253 CALLE PECOS
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-2350
Country	:	US
Telephone Number	:	805-660-3356
Fax Number	:

Provider Business Practice Location Address
First Line	:	1109 VAN NUYS ST
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92109-1253
Country	:	US
Telephone Number	:	805-660-3356
Fax Number	:

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

Provider Enumeration Date	:	06/13/2011
Last Update Date	:	03/27/2021

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