Provider Demographics
NPI:1679755383
Name:TODD, KAREN A (PA)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:A
Last Name:TODD
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:4767 E HARVEST RD
Mailing Address - Street 2:
Mailing Address - City:ACAMPO
Mailing Address - State:CA
Mailing Address - Zip Code:95220-9517
Mailing Address - Country:US
Mailing Address - Phone:209-339-9133
Mailing Address - Fax:209-339-1295
Practice Address - Street 1:4767 E HARVEST RD
Practice Address - Street 2:
Practice Address - City:ACAMPO
Practice Address - State:CA
Practice Address - Zip Code:95220-9517
Practice Address - Country:US
Practice Address - Phone:209-339-9133
Practice Address - Fax:209-339-1295
Is Sole Proprietor?:No
Enumeration Date:2007-12-04
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA20249363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant