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General NPI Number Information
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NPI Number | 1093060386
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Entity Type | Individual
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Provider Name | MARK ASHBY PA
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Gender | Male
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Dates
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Enumeration Date | 07/23/2012
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Last Update Date | 11/04/2016
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Provider Practice Location Address
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Address Line | 13547 VENTURA BLVD STE 282
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-3825
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Country | US
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Telephone | 818-968-4242
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Fax | 818-968-4242
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Provider Business Mailing Address
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Address Line | 4310 GREENBUSH AVE
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City | SHERMAN OAKS
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State | CA
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Zip | 91423-3911
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Country | US
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Telephone | 818-968-4242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA22159
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License Number State | CA
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