Provider Demographics
NPI:1568697795
Name:PALLAN, ROSA MARIA (PAC)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:MARIA
Last Name:PALLAN
Suffix:
Gender:F
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3559 GAGE AVE
Mailing Address - Street 2:
Mailing Address - City:BELL
Mailing Address - State:CA
Mailing Address - Zip Code:90201-1049
Mailing Address - Country:US
Mailing Address - Phone:323-581-8485
Mailing Address - Fax:323-923-2809
Practice Address - Street 1:3559 GAGE AVE
Practice Address - Street 2:
Practice Address - City:BELL
Practice Address - State:CA
Practice Address - Zip Code:90201-1049
Practice Address - Country:US
Practice Address - Phone:323-581-8485
Practice Address - Fax:323-923-2809
Is Sole Proprietor?:No
Enumeration Date:2009-05-18
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20133363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA20133OtherLICENSE CA