Provider Demographics
NPI:1053543470
Name:RHODES, ANDREA BUSCH (PA-C)
Entity type:Individual
Prefix:
First Name:ANDREA
Middle Name:BUSCH
Last Name:RHODES
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 1:2323 DE LA VINA ST STE 201
Mailing Address - Street 2:
Mailing Address - City:SANTA BARBARA
Mailing Address - State:CA
Mailing Address - Zip Code:93105-3879
Mailing Address - Country:US
Mailing Address - Phone:805-682-2267
Mailing Address - Fax:805-563-0970
Practice Address - Street 1:2323 DE LA VINA ST STE 201
Practice Address - Street 2:
Practice Address - City:SANTA BARBARA
Practice Address - State:CA
Practice Address - Zip Code:93105-3879
Practice Address - Country:US
Practice Address - Phone:805-682-2267
Practice Address - Fax:805-563-0970
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA52212363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA52212OtherCALIFORNIA STATE PHYSICIAN ASSISTANT LICENSE