Provider Demographics
NPI:1093060386
Name:ASHBY, MARK (PA)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ASHBY
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4310 GREENBUSH AVE
Mailing Address - Street 2:
Mailing Address - City:SHERMAN OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91423-3911
Mailing Address - Country:US
Mailing Address - Phone:818-968-4242
Mailing Address - Fax:
Practice Address - Street 1:13547 VENTURA BLVD STE 282
Practice Address - Street 2:
Practice Address - City:SHERMAN OAKS
Practice Address - State:CA
Practice Address - Zip Code:91423-3825
Practice Address - Country:US
Practice Address - Phone:818-968-4242
Practice Address - Fax:818-968-4242
Is Sole Proprietor?:No
Enumeration Date:2012-07-23
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA22159363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty