Provider Demographics
NPI:1710006473
Name:MAJABO, ANITA NIYIGENA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:ANITA
Middle Name:NIYIGENA
Last Name:MAJABO
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 W ARBOR DR
Mailing Address - Street 2:MC 8784
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92103-9001
Mailing Address - Country:US
Mailing Address - Phone:619-543-5990
Mailing Address - Fax:619-543-5445
Practice Address - Street 1:200 W ARBOR DR
Practice Address - Street 2:MC 8784
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92103-9001
Practice Address - Country:US
Practice Address - Phone:619-543-7178
Practice Address - Fax:619-543-5445
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA18601363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant