MEDICARE: NATALIE CALIDA VIZCARRA PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA23026	CA

General Provider Information

NPI Number	:	1184063554
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NATALIE CALIDA VIZCARRA PA-C

Provider Business Mailing Address
First Line	:	2021 MAIN ST
Second Line	:
City	:	OAKLEY
State	:	CA
Zip	:	94561-3302
Country	:	US
Telephone Number	:	925-776-8200
Fax Number	:	925-776-8260

Provider Business Practice Location Address
First Line	:	1040 ELM AVE STE 200
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90813-3266
Country	:	US
Telephone Number	:	562-624-4999
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/19/2013
Last Update Date	:	08/10/2023

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