Individual
MARY F EANES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA
Contact information
Practice address
9700 EL CAMINO REAL, SUITE 100, ATASCADERO, CA 93422-5569
(805) 461-9000
(805) 461-9001
Mailing address
9700 EL CAMOINO REAL, SUITE 100, ATASCADERO, CA 93422-5571
(805) 461-9000
(805) 461-9001
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 12590
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PA 12590
MEDICAL LICENSE #
CA
Enumeration date
11/08/2006
Last updated
04/25/2008
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