Provider Demographics
NPI:1407079221
Name:POMERANTZ, WENDY (PA, C , LA,C)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:POMERANTZ
Suffix:
Gender:F
Credentials:PA, C , LA,C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 ALTA ARDEN EXPY STE 3
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95825-2121
Mailing Address - Country:US
Mailing Address - Phone:916-489-4400
Mailing Address - Fax:916-489-1710
Practice Address - Street 1:3301 ALTA ARDEN EXPY STE 3
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2121
Practice Address - Country:US
Practice Address - Phone:916-489-4400
Practice Address - Fax:916-489-1710
Is Sole Proprietor?:No
Enumeration Date:2007-04-10
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13392363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAC 5619OtherACUPUNTURE LICENSE #
CAMP1206019OtherDEA #