Provider Demographics
NPI:1295867919
Name:MEIJER, ROSALIE LORIAN (PA-C, MMS)
Entity Type:Individual
Prefix:
First Name:ROSALIE
Middle Name:LORIAN
Last Name:MEIJER
Suffix:
Gender:F
Credentials:PA-C, MMS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 KINGSTON AVE APT C
Mailing Address - Street 2:
Mailing Address - City:GOLETA
Mailing Address - State:CA
Mailing Address - Zip Code:93117-2322
Mailing Address - Country:US
Mailing Address - Phone:805-692-0725
Mailing Address - Fax:805-569-7890
Practice Address - Street 1:320 W PUEBLO ST
Practice Address - Street 2:SANTA BARBARA COTTAGE HOSPITAL - TRAUMA SERVICES
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-4311
Practice Address - Country:US
Practice Address - Phone:805-569-7451
Practice Address - Fax:805-569-7890
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA-16300363A00000X
FL9101798363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP54776Medicare UPIN