Provider Demographics
NPI:1598345407
Name:PAN, MARGARET (PA)
Entity Type:Individual
Prefix:
First Name:MARGARET
Middle Name:
Last Name:PAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:MAGGIE
Other - Middle Name:
Other - Last Name:PAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:345 SAXONY RD STE 202
Mailing Address - Street 2:
Mailing Address - City:ENCINITAS
Mailing Address - State:CA
Mailing Address - Zip Code:92024-2787
Mailing Address - Country:US
Mailing Address - Phone:760-230-6660
Mailing Address - Fax:
Practice Address - Street 1:345 SAXONY RD STE 202
Practice Address - Street 2:
Practice Address - City:ENCINITAS
Practice Address - State:CA
Practice Address - Zip Code:92024-2787
Practice Address - Country:US
Practice Address - Phone:760-230-6660
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-13
Last Update Date:2022-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA61302363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant