Provider Demographics
NPI:1932883147
Name:PREDAZZI, MICAELA ANALIA
Entity Type:Individual
Prefix:
First Name:MICAELA
Middle Name:ANALIA
Last Name:PREDAZZI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MICAELA
Other - Middle Name:ANALIA
Other - Last Name:SEEDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 S STRATFORD AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA MARIA
Mailing Address - State:CA
Mailing Address - Zip Code:93454-5903
Mailing Address - Country:US
Mailing Address - Phone:805-739-3863
Mailing Address - Fax:805-614-2035
Practice Address - Street 1:300 S STRATFORD AVE
Practice Address - Street 2:
Practice Address - City:SANTA MARIA
Practice Address - State:CA
Practice Address - Zip Code:93454-5903
Practice Address - Country:US
Practice Address - Phone:805-739-3863
Practice Address - Fax:805-614-2035
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-09
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95026775363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner