Provider Demographics
NPI:1689451510
Name:AG HEALTH, PHYSICIAN ASSISTANT AND ASSOCIATES, INC.
Entity Type:Organization
Organization Name:AG HEALTH, PHYSICIAN ASSISTANT AND ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAFAELLA
Authorized Official - Middle Name:
Authorized Official - Last Name:DEBERNARDI
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:831-244-0497
Mailing Address - Street 1:1188 PADRE DR STE 113
Mailing Address - Street 2:
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93901-2261
Mailing Address - Country:US
Mailing Address - Phone:831-244-0497
Mailing Address - Fax:775-490-0211
Practice Address - Street 1:1188 PADRE DR STE 113
Practice Address - Street 2:
Practice Address - City:SALINAS
Practice Address - State:CA
Practice Address - Zip Code:93901-2261
Practice Address - Country:US
Practice Address - Phone:831-244-0497
Practice Address - Fax:775-490-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-13
Last Update Date:2024-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1487197141Medicaid
CA1487197141Medicaid