Healthcare Provider Details

I. General information

NPI: 1124053483
Provider Name (Legal Business Name): MARA ADELMAN PHYSICIANS ASST PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2006
Last Update Date: 04/03/2026
Certification Date: 04/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

470 CHADBOURNE RD STE A
FAIRFIELD CA
94534-9620
US

IV. Provider business mailing address

1141 PEAR TREE LN
NAPA CA
94558-6484
US

V. Phone/Fax

Practice location:
  • Phone: 866-268-4489
  • Fax:
Mailing address:
  • Phone: 707-254-1770
  • Fax: 707-254-1779

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA17260
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: