Provider Demographics
NPI:1093743015
Name:MACASADIA, MARITES N (PA)
Entity Type:Individual
Prefix:MRS
First Name:MARITES
Middle Name:N
Last Name:MACASADIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 EUCLID AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-2951
Mailing Address - Country:US
Mailing Address - Phone:619-527-7700
Mailing Address - Fax:619-527-2336
Practice Address - Street 1:610 EUCLID AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-2951
Practice Address - Country:US
Practice Address - Phone:619-527-7700
Practice Address - Fax:619-527-2336
Is Sole Proprietor?:No
Enumeration Date:2006-06-29
Last Update Date:2020-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15254363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0062450Medicaid
CAGR0062450Medicaid
CAGR0062450Medicaid