Healthcare Provider Details

I. General information

NPI: 1528758018
Provider Name (Legal Business Name): AISTE MILIAUSKAITE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/09/2023
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1081 MARKET PL STE 500
SAN RAMON CA
94583-4750
US

IV. Provider business mailing address

4847 HOPYARD RD STE 4387
PLEASANTON CA
94588-3360
US

V. Phone/Fax

Practice location:
  • Phone: 669-235-4188
  • Fax: 669-235-4221
Mailing address:
  • Phone: 669-235-4188
  • Fax: 669-235-4221

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA65116
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: