Provider Demographics
NPI:1407022163
Name:AMPUDIA, MARIA TERESA (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:TERESA
Last Name:AMPUDIA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W ROMNEYA DRIVE SUITE 203
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92801
Mailing Address - Country:US
Mailing Address - Phone:714-999-1465
Mailing Address - Fax:714-999-1701
Practice Address - Street 1:1801 W ROMNEYA DRIVE SUITE 203
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92801
Practice Address - Country:US
Practice Address - Phone:714-999-1465
Practice Address - Fax:714-999-1701
Is Sole Proprietor?:No
Enumeration Date:2008-05-02
Last Update Date:2014-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15438363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical