Provider Demographics
NPI:1427368786
Name:MYERS MCNAMARA, PAIGE MICHELLE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:PAIGE
Middle Name:MICHELLE
Last Name:MYERS MCNAMARA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:PAIGE
Other - Middle Name:MICHELLE
Other - Last Name:MYERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:224 N FAIR OAKS AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91103-3618
Mailing Address - Country:US
Mailing Address - Phone:626-696-1400
Mailing Address - Fax:626-696-1451
Practice Address - Street 1:1325 E COOLEY DR STE 101
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-3966
Practice Address - Country:US
Practice Address - Phone:909-204-7860
Practice Address - Fax:909-204-7861
Is Sole Proprietor?:No
Enumeration Date:2010-10-20
Last Update Date:2024-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA12893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant