Healthcare Provider Details

I. General information

NPI: 1093064107
Provider Name (Legal Business Name): JAMES M MABRY PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/05/2012
Last Update Date: 05/06/2026
Certification Date: 05/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 SIERRA COLLEGE DR STE 120
GRASS VALLEY CA
95945-5088
US

IV. Provider business mailing address

3400 DATA DR
RANCHO CORDOVA CA
95670-7956
US

V. Phone/Fax

Practice location:
  • Phone: 530-274-6222
  • Fax: 530-242-4846
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License NumberPA22458
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: