Provider Demographics
NPI:1710973862
Name:ACEVES, MARIA G (PA-C)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:G
Last Name:ACEVES
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 1:134 WALNUT HILLS DR
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-4429
Mailing Address - Country:US
Mailing Address - Phone:760-902-3935
Mailing Address - Fax:760-471-2516
Practice Address - Street 1:15725 POMERADO RD
Practice Address - Street 2:SUITE 107
Practice Address - City:POWAY
Practice Address - State:CA
Practice Address - Zip Code:92064-2068
Practice Address - Country:US
Practice Address - Phone:858-453-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2012-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15588363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA15588AMedicare ID - Type Unspecified
CAP52279Medicare UPIN