Provider Demographics
NPI:1417305616
Name:SPEARS, MARIA JANELLE H (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA JANELLE
Middle Name:H
Last Name:SPEARS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARIA JANELLE
Other - Middle Name:B
Other - Last Name:HERNANDEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:924 38TH ST APT 2
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4632
Mailing Address - Country:US
Mailing Address - Phone:650-455-0019
Mailing Address - Fax:
Practice Address - Street 1:924 38TH ST APT 2
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4632
Practice Address - Country:US
Practice Address - Phone:650-455-0019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA53434363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant