Provider Demographics
NPI:1073753513
Name:SPURR, ROBERTA (PA)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:
Last Name:SPURR
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9099 SOQUEL DR
Mailing Address - Street 2:BLDG 7
Mailing Address - City:APTOS
Mailing Address - State:CA
Mailing Address - Zip Code:95003-4033
Mailing Address - Country:US
Mailing Address - Phone:831-662-2997
Mailing Address - Fax:831-662-3888
Practice Address - Street 1:9099 SOQUEL DR
Practice Address - Street 2:BLDG 7
Practice Address - City:APTOS
Practice Address - State:CA
Practice Address - Zip Code:95003-4033
Practice Address - Country:US
Practice Address - Phone:831-662-2997
Practice Address - Fax:831-662-3888
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-24
Last Update Date:2009-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11419363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA11419OtherCA LICENSE