Provider Demographics
NPI:1821506940
Name:KRAMER, NICOLE ADRIANNA (PA-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:ADRIANNA
Last Name:KRAMER
Suffix:
Gender:F
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 1:27799 MEDICAL CENTER RD
Mailing Address - Street 2:STE 440
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-6400
Mailing Address - Country:US
Mailing Address - Phone:714-655-4390
Mailing Address - Fax:
Practice Address - Street 1:6553 E PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4202
Practice Address - Country:US
Practice Address - Phone:562-596-8700
Practice Address - Fax:562-596-8708
Is Sole Proprietor?:No
Enumeration Date:2018-01-11
Last Update Date:2021-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA55020363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant