MEDICARE: MRS. RENEE PAGAL ALSISTO-PAGATPATAN 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	PA17501	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA17501	OTHER	CA	CA PA COMMITTEE
2	PA17501	OTHER	CA	PA CA LICENSE NUMBER

General Provider Information

NPI Number	:	1447491980
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RENEE PAGAL ALSISTO-PAGATPATAN PA-C

Provider Business Mailing Address
First Line	:	1339 W. WILLOW STREET
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90810
Country	:	US
Telephone Number	:	562-492-6698
Fax Number	:	562-492-9553

Provider Business Practice Location Address
First Line	:	1339 W. WILLOW STREET
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90810
Country	:	US
Telephone Number	:	562-492-6698
Fax Number	:	562-492-9553

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

Provider Enumeration Date	:	03/12/2009
Last Update Date	:	11/22/2011

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