Provider Demographics
NPI:1083845887
Name:GERBRANDT, STACEY AMBER (PA-C)
Entity type:Individual
Prefix:
First Name:STACEY
Middle Name:AMBER
Last Name:GERBRANDT
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 1:27879 SMYTH DR
Mailing Address - Street 2:
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-4011
Mailing Address - Country:US
Mailing Address - Phone:661-259-2500
Mailing Address - Fax:
Practice Address - Street 1:27879 SMYTH DR
Practice Address - Street 2:
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-4011
Practice Address - Country:US
Practice Address - Phone:661-259-2500
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-28
Last Update Date:2020-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20424363AS0400X
CA20424207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical