Provider Demographics
NPI:1134130875
Name:AIRD, MARCOS ALI (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARCOS
Middle Name:ALI
Last Name:AIRD
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:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:JOLON
Mailing Address - State:CA
Mailing Address - Zip Code:93928-0609
Mailing Address - Country:US
Mailing Address - Phone:707-344-8928
Mailing Address - Fax:
Practice Address - Street 1:19510 VAN BUREN BLVD
Practice Address - Street 2:STE F3, BOX 457
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92508
Practice Address - Country:US
Practice Address - Phone:707-344-8928
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-10
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant