Individual
APRIL MAE AUGUST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
301 S FAIR OAKS AVE, PASADENA, CA 91105-2561
(626) 683-9204
Mailing address
2355 GLENDALE BLVD APT 1, LOS ANGELES, CA 90039-3258
(214) 701-9376
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
1182118
CA
363A00000X
Physician Assistant
Primary
59102
CA
Other
Enumeration date
11/24/2020
Last updated
02/09/2021
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