Provider Demographics
NPI:1568891851
Name:ROJAS, MICHELE GAIL (PA)
Entity Type:Individual
Prefix:MRS
First Name:MICHELE
Middle Name:GAIL
Last Name:ROJAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:MRS
Other - First Name:MICHELE
Other - Middle Name:GAIL
Other - Last Name:MESSIAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:1050 INGRAHAM ST
Mailing Address - Street 2:334
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90017-1989
Mailing Address - Country:US
Mailing Address - Phone:310-779-6660
Mailing Address - Fax:
Practice Address - Street 1:1050 INGRAHAM ST
Practice Address - Street 2:334
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90017-1989
Practice Address - Country:US
Practice Address - Phone:310-779-6660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA23299363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical