Individual
JUSTIN BENTLEY ANDERSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
22 CORPORATE PLAZA DR, NEWPORT BEACH, CA 92660-7985
(949) 722-7038
(949) 630-4900
Mailing address
22 CORPORATE PLAZA DR, NEWPORT BEACH, CA 92660-7985
(949) 722-7038
(949) 630-4900
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA21823
CA
363AS0400X
Surgical Physician Assistant
Primary
PA21823
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
FT736Y
PTAN
CA
Enumeration date
01/12/2012
Last updated
11/29/2021
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