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Individual

ALICIA IGLESIAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
MS, PA-C

Contact information

Practice address
9939 MAGNOLIA AVE, RIVERSIDE, CA 92503-3528
(951) 687-8802
(951) 687-2250
Mailing address
3301 W THORNTON AVE, ANAHEIM, CA 92804-4714
(714) 270-4712

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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