Provider Demographics
NPI:1518260553
Name:AIMONE, MARY O (PA-C)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:O
Last Name:AIMONE
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 1:4910 AIRPORT PLAZA DR STE 210
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815-1377
Mailing Address - Country:US
Mailing Address - Phone:562-421-3727
Mailing Address - Fax:624-208-9485
Practice Address - Street 1:4910 AIRPORT PLAZA DR STE 210
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90815-1377
Practice Address - Country:US
Practice Address - Phone:562-421-3727
Practice Address - Fax:562-420-8948
Is Sole Proprietor?:No
Enumeration Date:2010-12-14
Last Update Date:2021-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13688363A00000X
CAPA13688363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB204665Medicare PIN