Provider Demographics
NPI:1194001990
Name:AYERS, MARISA ELIZABETH (PA)
Entity Type:Individual
Prefix:MS
First Name:MARISA
Middle Name:ELIZABETH
Last Name:AYERS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:935 NEWPORT AVE
Mailing Address - Street 2:
Mailing Address - City:GROVER BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:93433-1711
Mailing Address - Country:US
Mailing Address - Phone:805-704-8943
Mailing Address - Fax:
Practice Address - Street 1:931 OAK PARK BLVD STE 101
Practice Address - Street 2:
Practice Address - City:PISMO BEACH
Practice Address - State:CA
Practice Address - Zip Code:93449-3403
Practice Address - Country:US
Practice Address - Phone:805-474-2600
Practice Address - Fax:805-474-2607
Is Sole Proprietor?:No
Enumeration Date:2011-10-25
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA21792363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF0123ZMedicare PIN