=====================================================
General NPI Number Information
=====================================================
NPI Number | 1134902299
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MARADY SABIAGA MESA PA-C, MPH
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2023
-----------------------------------------------------
Last Update Date | 05/14/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2100 STATHAM BLVD
-----------------------------------------------------
City | OXNARD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93033
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-330-8685
-----------------------------------------------------
Fax | 805-367-5250
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1040 FLYNN RD
-----------------------------------------------------
City | CAMARILLO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93012-5092
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 805-673-3930
-----------------------------------------------------
Fax | 805-659-3217
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AM0700X
-----------------------------------------------------
Taxonomy Name | Medical Physician Assistant
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363A00000X
-----------------------------------------------------
Taxonomy Name | Physician Assistant
-----------------------------------------------------
License Number | PA63644
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------