Provider Demographics
NPI:1609279207
Name:HANDEL, DUSTIN CRAIG (PA-C)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:CRAIG
Last Name:HANDEL
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 1:125 COLUMBIA
Mailing Address - Street 2:STE A
Mailing Address - City:ALISO VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92656-4157
Mailing Address - Country:US
Mailing Address - Phone:949-388-3131
Mailing Address - Fax:949-429-0623
Practice Address - Street 1:9045 BRUCEVILLE RD STE 100
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95758-5950
Practice Address - Country:US
Practice Address - Phone:916-479-9110
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-09-27
Last Update Date:2016-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant