Provider Demographics
NPI:1619957131
Name:PAJA, MARCELLE A (PT)
Entity Type:Individual
Prefix:MRS
First Name:MARCELLE
Middle Name:A
Last Name:PAJA
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:25971 PALA
Mailing Address - Street 2:SUITE 110
Mailing Address - City:MISSION VIEJO
Mailing Address - State:CA
Mailing Address - Zip Code:92691-2742
Mailing Address - Country:US
Mailing Address - Phone:949-465-9500
Mailing Address - Fax:949-465-9506
Practice Address - Street 1:25971 PALA
Practice Address - Street 2:SUITE 110
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-2742
Practice Address - Country:US
Practice Address - Phone:949-465-9500
Practice Address - Fax:949-465-9506
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2010-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT32192208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPT32192AMedicare UPIN