Provider Demographics
NPI:1093021008
Name:ARCHILA, AUDREY ISABELLA (PA-C)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:ISABELLA
Last Name:ARCHILA
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 1:4770 N CEDAR AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93726-1065
Mailing Address - Country:US
Mailing Address - Phone:559-255-6476
Mailing Address - Fax:559-255-7906
Practice Address - Street 1:4770 N CEDAR AVE
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93726-1065
Practice Address - Country:US
Practice Address - Phone:559-860-4900
Practice Address - Fax:559-255-7906
Is Sole Proprietor?:No
Enumeration Date:2010-08-27
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21120363A00000X
CAPA21120363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant