Healthcare Provider Details

I. General information

NPI: 1114354040
Provider Name (Legal Business Name): THOMAS ANTHONY PAYEA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2013
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25500 MEDICAL CENTER DR
MURRIETA CA
92562-5965
US

IV. Provider business mailing address

1874 BURNT MAPLE WAY
VISTA CA
92081-7357
US

V. Phone/Fax

Practice location:
  • Phone: 951-696-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA23306
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: