MEDICARE: MS. ANDREA POGUE 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	PA20649	CA

General Provider Information

NPI Number	:	1619125200
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. ANDREA POGUE PA-C

Provider Business Mailing Address
First Line	:	PO BOX 10301
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92711-0301
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	25495 MEDICAL CENTER DR STE 204
Second Line	:
City	:	MURRIETA
State	:	CA
Zip	:	92562-4903
Country	:	US
Telephone Number	:	951-698-1901
Fax Number	:	951-364-3639

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

Provider Enumeration Date	:	09/08/2008
Last Update Date	:	08/30/2024

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