Provider Demographics
NPI:1760894547
Name:BAJADA, ADA PATRICIA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ADA
Middle Name:PATRICIA
Last Name:BAJADA
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:ADA
Other - Middle Name:PATRICIA
Other - Last Name:GONZALEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:77 ESCANYO DR
Mailing Address - Street 2:
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-4133
Mailing Address - Country:US
Mailing Address - Phone:650-989-8934
Mailing Address - Fax:
Practice Address - Street 1:77 ESCANYO DR
Practice Address - Street 2:
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-4133
Practice Address - Country:US
Practice Address - Phone:650-989-8934
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-28
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000514363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily