Provider Demographics
NPI:1336284074
Name:GHARIB, RITTA M (PA-C)
Entity Type:Individual
Prefix:MS
First Name:RITTA
Middle Name:M
Last Name:GHARIB
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:FILE# 54433
Mailing Address - Street 2:SUITE #409
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90074-4433
Mailing Address - Country:US
Mailing Address - Phone:858-784-5888
Mailing Address - Fax:858-784-5960
Practice Address - Street 1:3811 VALLEY CENTRE DR
Practice Address - Street 2:MAIL DROP S99
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92130-1111
Practice Address - Country:US
Practice Address - Phone:858-764-3280
Practice Address - Fax:858-764-3299
Is Sole Proprietor?:No
Enumeration Date:2007-02-20
Last Update Date:2011-07-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA15121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFB135ZMedicare UPIN