Healthcare Provider Details

I. General information

NPI: 1710973862
Provider Name (Legal Business Name): MARIA G. ACEVES PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2005
Last Update Date: 09/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15725 POMERADO RD SUITE 107
POWAY CA
92064-2068
US

IV. Provider business mailing address

134 WALNUT HILLS DR
SAN MARCOS CA
92078-4429
US

V. Phone/Fax

Practice location:
  • Phone: 858-453-7700
  • Fax:
Mailing address:
  • Phone: 760-902-3935
  • Fax: 760-471-2516

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA15588
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: