1427368786 NPI number — MS. PAIGE MICHELLE MYERS MCNAMARA PA-C

Table of content: MS. PAIGE MICHELLE MYERS MCNAMARA PA-C (NPI 1427368786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1427368786 NPI number — MS. PAIGE MICHELLE MYERS MCNAMARA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MYERS MCNAMARA
Provider First Name:
PAIGE
Provider Middle Name:
MICHELLE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MYERS
Provider Other First Name:
PAIGE
Provider Other Middle Name:
MICHELLE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PA-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1427368786
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/15/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
224 N FAIR OAKS AVE STE 300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91103-3618
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-696-1400
Provider Business Mailing Address Fax Number:
626-696-1451

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1325 E COOLEY DR STE 101
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
COLTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92324-3966
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
909-204-7860
Provider Business Practice Location Address Fax Number:
909-204-7861
Provider Enumeration Date:
10/20/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363A00000X , with the licence number:  PA12893 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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