Provider Demographics
NPI:1902407679
Name:SPINNER, SAMANTHA SIDNEY (PA-C)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:SIDNEY
Last Name:SPINNER
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 1:6121 HOLLIS ST STE 400
Mailing Address - Street 2:
Mailing Address - City:EMERYVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94608-2077
Mailing Address - Country:US
Mailing Address - Phone:510-266-5400
Mailing Address - Fax:
Practice Address - Street 1:6121 HOLLIS ST STE 400
Practice Address - Street 2:
Practice Address - City:EMERYVILLE
Practice Address - State:CA
Practice Address - Zip Code:94608-2077
Practice Address - Country:US
Practice Address - Phone:510-266-5400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-08
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA59235363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant