Provider Demographics
NPI:1043851371
Name:DOVE, HELEN ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:HELEN
Middle Name:ANN
Last Name:DOVE
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ANNIE
Other - Middle Name:
Other - Last Name:DOVE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:519 E MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91205-2370
Mailing Address - Country:US
Mailing Address - Phone:518-429-7277
Mailing Address - Fax:
Practice Address - Street 1:1509 WILSON TER
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91206-4007
Practice Address - Country:US
Practice Address - Phone:818-863-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-10-08
Last Update Date:2022-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA57263363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant