Provider Demographics
NPI:1487862793
Name:DEGRACIA, MARIA FRANCINA (PA)
Entity Type:Individual
Prefix:MS
First Name:MARIA
Middle Name:FRANCINA
Last Name:DEGRACIA
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MARIA
Other - Middle Name:FRANCINA
Other - Last Name:STRYBOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA
Mailing Address - Street 1:1630 DONNER WAY
Mailing Address - Street 2:
Mailing Address - City:WOODLAND
Mailing Address - State:CA
Mailing Address - Zip Code:95695-5564
Mailing Address - Country:US
Mailing Address - Phone:530-668-6195
Mailing Address - Fax:
Practice Address - Street 1:1630 DONNER WAY
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-5564
Practice Address - Country:US
Practice Address - Phone:530-668-6195
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-18
Last Update Date:2010-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14890363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant