Provider Demographics
NPI:1023026192
Name:MURDOCK, MARY C (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MARY
Middle Name:C
Last Name:MURDOCK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 BREA BLVD APT 3
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92835-3946
Mailing Address - Country:US
Mailing Address - Phone:714-369-3233
Mailing Address - Fax:
Practice Address - Street 1:539 S BREA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:BREA
Practice Address - State:CA
Practice Address - Zip Code:92821-5377
Practice Address - Country:US
Practice Address - Phone:714-671-2936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 17168363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical