MEDICARE: MISS ANITA NIYIGENA MAJABO PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	18601	CA

General Provider Information

NPI Number	:	1710006473
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS ANITA NIYIGENA MAJABO PA-C

Provider Business Mailing Address
First Line	:	200 W ARBOR DR
Second Line	:	MC 8784
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-9001
Country	:	US
Telephone Number	:	619-543-5990
Fax Number	:	619-543-5445

Provider Business Practice Location Address
First Line	:	200 W ARBOR DR
Second Line	:	MC 8784
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-9001
Country	:	US
Telephone Number	:	619-543-7178
Fax Number	:	619-543-5445

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/27/2007
Last Update Date	:	05/05/2008

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