Provider Demographics
NPI:1669493516
Name:VANTROBA, JEFFREY C (PA-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:VANTROBA
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 1:3911 CASTLEVALE RD
Mailing Address - Street 2:
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98902-7807
Mailing Address - Country:US
Mailing Address - Phone:509-966-7899
Mailing Address - Fax:509-225-6811
Practice Address - Street 1:3911 CASTLEVALE RD STE 301
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98902-7807
Practice Address - Country:US
Practice Address - Phone:509-966-7899
Practice Address - Fax:509-225-6811
Is Sole Proprietor?:No
Enumeration Date:2006-07-23
Last Update Date:2020-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10003839363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical