Provider Demographics
NPI:1154628105
Name:AMBROSIO, JOEL PAUL (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JOEL
Middle Name:PAUL
Last Name:AMBROSIO
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:400 29TH ST
Mailing Address - Street 2:SUITE 501
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3522
Mailing Address - Country:US
Mailing Address - Phone:510-268-1800
Mailing Address - Fax:510-268-1803
Practice Address - Street 1:400 29TH ST
Practice Address - Street 2:SUITE 501
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3522
Practice Address - Country:US
Practice Address - Phone:510-268-1800
Practice Address - Fax:510-268-1803
Is Sole Proprietor?:No
Enumeration Date:2011-02-26
Last Update Date:2020-07-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA21498363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant