Healthcare Provider Details

I. General information

NPI: 1215019575
Provider Name (Legal Business Name): MAUREEN OHARA PAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/19/2006
Last Update Date: 02/26/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7601 EAST IMPERIAL HWY ROOM HB145
DOWNEY CA
90242
US

IV. Provider business mailing address

4576 TWINING STREET
LOS ANGELES CA
90032-2033
US

V. Phone/Fax

Practice location:
  • Phone: 562-401-7225
  • Fax: 562-401-7615
Mailing address:
  • Phone: 323-222-6454
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA12723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: