Individual
MUOI LOI
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
600 B ST, LIVINGSTON, CA 95334-9593
(209) 850-3500
Mailing address
600 B ST, LIVINGSTON, CA 95334-9593
(999) 999-9999
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
25MP00857300
NJ
363AM0700X
Medical Physician Assistant
MA065824
PA
363AM0700X
Medical Physician Assistant
PA65185
CA
Other
Enumeration date
09/24/2024
Last updated
10/20/2025
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