Healthcare Provider Details

I. General information

NPI: 1275316507
Provider Name (Legal Business Name): MADELINE ROSE PARKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2023
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

215 LENNON LN STE 200
WALNUT CREEK CA
94598-2543
US

IV. Provider business mailing address

1756 CARMEL DR APT 306
WALNUT CREEK CA
94596-7217
US

V. Phone/Fax

Practice location:
  • Phone: 925-685-4224
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA66521
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RE0101X
TaxonomyEndocrinology, Diabetes & Metabolism Physician
License NumberPA66521
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: