Provider Demographics
NPI:1366501256
Name:BIEDEBACH, ALINA ATTAI (PAC)
Entity Type:Individual
Prefix:
First Name:ALINA
Middle Name:ATTAI
Last Name:BIEDEBACH
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:SAN ANTONIO
Other - Middle Name:
Other - Last Name:HEALTH CARE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:3089 GRANDOAKS DR
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91361-5577
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:17756 SATICOY ST
Practice Address - Street 2:
Practice Address - City:RESEDA
Practice Address - State:CA
Practice Address - Zip Code:91335-3381
Practice Address - Country:US
Practice Address - Phone:818-757-3068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPAC13996363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPAC13996OtherLICENSE