Provider Demographics
NPI:1235416710
Name:HIPOL, MANUEL ANTONIO (PA)
Entity Type:Individual
Prefix:MR
First Name:MANUEL
Middle Name:ANTONIO
Last Name:HIPOL
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:MANUEL
Other - Middle Name:ANTONIO
Other - Last Name:HIPOL-ALDRICH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:37313 MAPLE ST
Mailing Address - Street 2:
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94536-4848
Mailing Address - Country:US
Mailing Address - Phone:408-404-5050
Mailing Address - Fax:408-404-5500
Practice Address - Street 1:37313 MAPLE ST
Practice Address - Street 2:
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94536-4848
Practice Address - Country:US
Practice Address - Phone:408-404-5050
Practice Address - Fax:408-404-5500
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15853363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical