Provider Demographics
NPI:1093089872
Name:FEROLI, MICHAEL ANTHONY (PA-C)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:ANTHONY
Last Name:FEROLI
Suffix:
Gender:M
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 1:615 WEATHERSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1096
Mailing Address - Country:US
Mailing Address - Phone:540-250-8263
Mailing Address - Fax:
Practice Address - Street 1:10538 MISSION GORGE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:SANTEE
Practice Address - State:CA
Practice Address - Zip Code:92071-3154
Practice Address - Country:US
Practice Address - Phone:619-456-0033
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2016-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110003801363A00000X
CA53575363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant