Provider Demographics
NPI:1689281594
Name:MA, CLAUDINE MAE (MSN NP)
Entity Type:Individual
Prefix:
First Name:CLAUDINE
Middle Name:MAE
Last Name:MA
Suffix:
Gender:F
Credentials:MSN NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25971 REED WAY
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-3888
Mailing Address - Country:US
Mailing Address - Phone:626-731-1632
Mailing Address - Fax:
Practice Address - Street 1:3972 N WATERMAN AVE STE 104
Practice Address - Street 2:
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92404-1767
Practice Address - Country:US
Practice Address - Phone:909-433-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95015113363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner