Provider Demographics
NPI:1477867893
Name:AMARGO, FIDELINO JARDINIANO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:FIDELINO
Middle Name:JARDINIANO
Last Name:AMARGO
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:41880 KALMIA ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92562-8831
Mailing Address - Country:US
Mailing Address - Phone:951-696-7587
Mailing Address - Fax:951-461-6973
Practice Address - Street 1:41880 KALMIA ST
Practice Address - Street 2:SUITE 100
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-8831
Practice Address - Country:US
Practice Address - Phone:951-696-7587
Practice Address - Fax:951-461-6973
Is Sole Proprietor?:No
Enumeration Date:2010-07-27
Last Update Date:2010-07-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA467220163W00000X
CAPA13145363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No163W00000XNursing Service ProvidersRegistered Nurse