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NPI Code Detail

MEDICARE: DINA MARIE MEDEIROS PA-C

MEDICARE: DINA MARIE MEDEIROS 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
1363A00000XPhysician AssistantPA18449CA

General Provider Information

NPI Number : 1649476011
Entity Type Code : Individual
Provider Name (Legal Business Name) : DINA MARIE MEDEIROS PA-C
Provider Business Mailing Address
First Line : 3400 DATA DR
Second Line :
City : RANCHO CORDOVA
State : CA
Zip : 95670-7956
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1264 HAWKS FLIGHT CT STE 100
Second Line :
City : EL DORADO HILLS
State : CA
Zip : 95762-9354
Country : US
Telephone Number : 916-939-8400
Fax Number : 916-939-8971
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/22/2007
Last Update Date : 01/05/2023

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