Provider Demographics
NPI:1033385117
Name:HARTMANN, MARK CHESTER (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:CHESTER
Last Name:HARTMANN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:10170 SORRENTO VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-1604
Mailing Address - Country:US
Mailing Address - Phone:858-784-5888
Mailing Address - Fax:
Practice Address - Street 1:380 STEVENS AVE STE 100
Practice Address - Street 2:
Practice Address - City:SOLANA BEACH
Practice Address - State:CA
Practice Address - Zip Code:92075-2068
Practice Address - Country:US
Practice Address - Phone:858-554-9800
Practice Address - Fax:858-755-5522
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-07
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA16511363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical