Basic Information
Provider Information
NPI: 1861910093
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: STEINHEISER
FirstName: AMANDA
MiddleName: MAY
NamePrefix:  
NameSuffix:  
Credential: PA-C
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 200 W CENTER STREET PROMENADE STE 400
Address2:  
City: ANAHEIM
State: CA
PostalCode: 928053960
CountryCode: US
TelephoneNumber: 7144494800
FaxNumber: 7144494956
Practice Location
Address1: 2826 HARRIS ST
Address2:  
City: EUREKA
State: CA
PostalCode: 955034809
CountryCode: US
TelephoneNumber: 7074438066
FaxNumber: 7072683251
Other Information
ProviderEnumerationDate: 09/08/2017
LastUpdateDate: 07/21/2022
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363A00000X  N Physician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant 

No ID Information.


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