Provider Demographics
NPI:1477620227
Name:SEITZ, SHAY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SHAY
Middle Name:
Last Name:SEITZ
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4027
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-8027
Mailing Address - Country:US
Mailing Address - Phone:100-000-0000
Mailing Address - Fax:
Practice Address - Street 1:6349 W. SUNSET BLVD.
Practice Address - Street 2:SUITE 600
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90028-7900
Practice Address - Country:US
Practice Address - Phone:714-642-6561
Practice Address - Fax:714-642-6561
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16043363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1477620227OtherNPI