Provider Demographics
NPI:1114124534
Name:DAVE, PREETI K (PA)
Entity Type:Individual
Prefix:
First Name:PREETI
Middle Name:K
Last Name:DAVE
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:PO BOX 2221
Mailing Address - Street 2:
Mailing Address - City:DOWNEY
Mailing Address - State:CA
Mailing Address - Zip Code:90242-0221
Mailing Address - Country:US
Mailing Address - Phone:562-261-5259
Mailing Address - Fax:562-261-5259
Practice Address - Street 1:1120 W WARNER AVE
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707-3179
Practice Address - Country:US
Practice Address - Phone:562-261-5259
Practice Address - Fax:562-261-5259
Is Sole Proprietor?:No
Enumeration Date:2007-06-29
Last Update Date:2007-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 15835363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant