Healthcare Provider Details

I. General information

NPI: 1588257125
Provider Name (Legal Business Name): NATALIE PAIGE KAING PA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: NATALIE PAIGE CANALES PA

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 06/28/2024
Certification Date: 06/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5 HUTTON CENTRE DR
SANTA ANA CA
92707-8714
US

IV. Provider business mailing address

PO BOX 10069
SAN BERNARDINO CA
92423-0069
US

V. Phone/Fax

Practice location:
  • Phone: 855-434-7763
  • Fax:
Mailing address:
  • Phone: 909-335-4188
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number59269
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: