Provider Demographics
NPI:1861787301
Name:ATLAS, ASHLEY PATTESON (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:PATTESON
Last Name:ATLAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ASHLEY
Other - Middle Name:PATTESON
Other - Last Name:LATHROP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1253 CALLE PECOS
Mailing Address - Street 2:
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360-2350
Mailing Address - Country:US
Mailing Address - Phone:805-660-3356
Mailing Address - Fax:
Practice Address - Street 1:1109 VAN NUYS ST
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92109-1253
Practice Address - Country:US
Practice Address - Phone:805-660-3356
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-06-13
Last Update Date:2021-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23304363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant