Provider Demographics
NPI:1063659829
Name:MACASIEB, JANELLE ROBLES (PA-C)
Entity Type:Individual
Prefix:
First Name:JANELLE
Middle Name:ROBLES
Last Name:MACASIEB
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 1:3110 COCHISE WAY
Mailing Address - Street 2:UNIT 95
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-4920
Mailing Address - Country:US
Mailing Address - Phone:714-522-3572
Mailing Address - Fax:
Practice Address - Street 1:23451 MADISON ST
Practice Address - Street 2:SUITE 290
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4763
Practice Address - Country:US
Practice Address - Phone:310-375-1246
Practice Address - Fax:310-375-0590
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2009-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20018363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant