Provider Demographics
NPI:1942843719
Name:SANTOS, STEPHANIE MARIE (PA-C)
Entity Type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:MARIE
Last Name:SANTOS
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 1:116 S PALISADE DR STE 208
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-8906
Mailing Address - Country:US
Mailing Address - Phone:805-922-3632
Mailing Address - Fax:805-922-3522
Practice Address - Street 1:116 S PALISADE DR STE 208
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-8906
Practice Address - Country:US
Practice Address - Phone:805-922-3632
Practice Address - Fax:805-922-3522
Is Sole Proprietor?:No
Enumeration Date:2019-10-23
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA2447363A00000X
CA59279363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant