Basic Information
| Provider Information | |||||||||
| NPI: | 1164880811 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KREMSREITER | ||||||||
| FirstName: | ANDREA | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 62106 | ||||||||
| Address2: | |||||||||
| City: | SANTA BARBARA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 931602106 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 2040 VIBORG RD STE 140 | ||||||||
| Address2: | |||||||||
| City: | SOLVANG | ||||||||
| State: | CA | ||||||||
| PostalCode: | 93463 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8056865370 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/09/2016 | ||||||||
| LastUpdateDate: | 10/28/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | PA55833 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 3937-23 | WI | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | PA55833 | 01 | CA | MEDICAL LICENSE | OTHER |