Provider Demographics
NPI:1093164808
Name:GERMAIN, NATASHA (PA-C)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:
Last Name:GERMAIN
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 1:12157 VICTORY BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH HOLLYWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:91606-3204
Mailing Address - Country:US
Mailing Address - Phone:818-755-8000
Mailing Address - Fax:818-432-6834
Practice Address - Street 1:12157 VICTORY BLVD
Practice Address - Street 2:
Practice Address - City:NORTH HOLLYWOOD
Practice Address - State:CA
Practice Address - Zip Code:91606-3204
Practice Address - Country:US
Practice Address - Phone:818-755-8000
Practice Address - Fax:818-432-6834
Is Sole Proprietor?:No
Enumeration Date:2016-06-13
Last Update Date:2022-05-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA53508363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical