Provider Demographics
NPI:1720356447
Name:LANTZ, AMBER DONN (PA)
Entity type:Individual
Prefix:
First Name:AMBER
Middle Name:DONN
Last Name:LANTZ
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 TRIANGLE CIR
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:NC
Mailing Address - Zip Code:28037-8033
Mailing Address - Country:US
Mailing Address - Phone:805-587-1193
Mailing Address - Fax:
Practice Address - Street 1:1070 COUNTRY CLUB DR
Practice Address - Street 2:SUITE C
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-8371
Practice Address - Country:US
Practice Address - Phone:805-306-0222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-08
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17529363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant