Provider Demographics
NPI:1427019702
Name:MINARD, ANNAMAE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ANNAMAE
Middle Name:
Last Name:MINARD
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 1:3619 HANCOCK DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-5015
Mailing Address - Country:US
Mailing Address - Phone:951-688-1171
Mailing Address - Fax:951-688-1196
Practice Address - Street 1:6848 MAGNOLIA AVE
Practice Address - Street 2:#250
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-2857
Practice Address - Country:US
Practice Address - Phone:951-682-1622
Practice Address - Fax:951-682-1268
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16007363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical