Provider Demographics
NPI:1730474834
Name:MUSKAT, MICA (NP)
Entity Type:Individual
Prefix:
First Name:MICA
Middle Name:
Last Name:MUSKAT
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:533 PARNASSUS AVE
Mailing Address - Street 2:ROOM U127, BOX 0105
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94143-0105
Mailing Address - Country:US
Mailing Address - Phone:415-476-9373
Mailing Address - Fax:415-502-7540
Practice Address - Street 1:533 PARNASSUS AVE
Practice Address - Street 2:ROOM U127, BOX 0105
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94143-0105
Practice Address - Country:US
Practice Address - Phone:415-476-9373
Practice Address - Fax:415-502-7540
Is Sole Proprietor?:No
Enumeration Date:2011-06-16
Last Update Date:2011-06-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA14776363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics