Provider Demographics
NPI:1326342072
Name:LOUIS, JUANITA TRICIA (MPA-C)
Entity Type:Individual
Prefix:
First Name:JUANITA
Middle Name:TRICIA
Last Name:LOUIS
Suffix:
Gender:F
Credentials:MPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1735 MARSH DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95901-8209
Mailing Address - Country:US
Mailing Address - Phone:347-528-9043
Mailing Address - Fax:
Practice Address - Street 1:5730 PACKARD AVE
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:CA
Practice Address - Zip Code:95901-7118
Practice Address - Country:US
Practice Address - Phone:530-749-3242
Practice Address - Fax:530-749-3248
Is Sole Proprietor?:No
Enumeration Date:2011-01-10
Last Update Date:2022-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY012291363AM0700X
CAPA61178363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical