Provider Demographics
NPI:1083024053
Name:ANFUSO, AMY HEATHER (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:HEATHER
Last Name:ANFUSO
Suffix:
Gender:F
Credentials:PA-C
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Other - Credentials:
Mailing Address - Street 1:1441 AVOCADO AVE #306
Mailing Address - Street 2:
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660
Mailing Address - Country:US
Mailing Address - Phone:949-644-8556
Mailing Address - Fax:949-644-8797
Practice Address - Street 1:1441 AVOCADO AVE #306
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660
Practice Address - Country:US
Practice Address - Phone:949-644-8556
Practice Address - Fax:949-644-8797
Is Sole Proprietor?:No
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical