Provider Demographics
NPI:1689826687
Name:MEINE, LEA J (PA)
Entity Type:Individual
Prefix:
First Name:LEA
Middle Name:J
Last Name:MEINE
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 28915
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-8915
Mailing Address - Country:US
Mailing Address - Phone:559-253-2800
Mailing Address - Fax:559-253-2800
Practice Address - Street 1:489 5TH AVE FL 3
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10017-6145
Practice Address - Country:US
Practice Address - Phone:212-440-0658
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-21
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19838363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA19838OtherCA P.A. LICENSE
CAAR408ZMedicare PIN