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Individual
ALICIA IGLESIAS
Active
Individual
ALICIA IGLESIAS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MS, PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA20551
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0083640-GR0083641
MEDICAL GROUP
CA
01
—
ZZZ19972Z-ZZZ20075Z
MEDICARE GROUP
CA
Enumeration date
01/29/2010
Last updated
07/08/2010
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