Provider Demographics
NPI:1275574709
Name:ANDERSON, ANASTASIA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:ANASTASIA
Middle Name:MARIE
Last Name:ANDERSON
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 1:2888 LONG BEACH BLVD
Mailing Address - Street 2:SUITE 240
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90806-1530
Mailing Address - Country:US
Mailing Address - Phone:562-595-7696
Mailing Address - Fax:562-490-3846
Practice Address - Street 1:2888 LONG BEACH BLVD
Practice Address - Street 2:SUITE 240
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1530
Practice Address - Country:US
Practice Address - Phone:562-595-7696
Practice Address - Fax:562-490-3846
Is Sole Proprietor?:No
Enumeration Date:2006-06-08
Last Update Date:2011-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17941363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW19727OtherGROUP ID
CA00G99710Medicaid
CAW19727OtherGROUP ID