Provider Demographics
NPI:1306364518
Name:ACEVEDO, PAULINA MARIE (PA-C)
Entity type:Individual
Prefix:
First Name:PAULINA
Middle Name:MARIE
Last Name:ACEVEDO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PAULINA
Other - Middle Name:
Other - Last Name:TO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2346 HARWOOD ST
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-1107
Mailing Address - Country:US
Mailing Address - Phone:213-880-0949
Mailing Address - Fax:
Practice Address - Street 1:225 W BROADWAY
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:CA
Practice Address - Zip Code:91204-1331
Practice Address - Country:US
Practice Address - Phone:818-545-7117
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-07
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54755363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant