Healthcare Provider Details

I. General information

NPI: 1194067728
Provider Name (Legal Business Name): NEIL CARL ADRIAN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/21/2013
Last Update Date: 03/22/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3180 COLLINS DR STE A
MERCED CA
95348-3156
US

IV. Provider business mailing address

3180 COLLINS DR STE A
MERCED CA
95348-3156
US

V. Phone/Fax

Practice location:
  • Phone: 209-349-8429
  • Fax: 209-720-0193
Mailing address:
  • Phone: 209-349-8429
  • Fax: 209-720-0193

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA22815
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: