Provider Demographics
NPI:1780675272
Name:STARR, KARIN M (PA)
Entity Type:Individual
Prefix:
First Name:KARIN
Middle Name:M
Last Name:STARR
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 1:5500 UNIVERSITY PKWY
Mailing Address - Street 2:CSUSB STUDENT HEALTH CENTER
Mailing Address - City:SAN BERNARDINO
Mailing Address - State:CA
Mailing Address - Zip Code:92407-2318
Mailing Address - Country:US
Mailing Address - Phone:909-537-5241
Mailing Address - Fax:909-537-5241
Practice Address - Street 1:5500 UNIVERSITY PKWY
Practice Address - Street 2:CSUSB STUDENT HEALTH CENTER
Practice Address - City:SAN BERNARDINO
Practice Address - State:CA
Practice Address - Zip Code:92407-2318
Practice Address - Country:US
Practice Address - Phone:909-537-5241
Practice Address - Fax:909-537-5241
Is Sole Proprietor?:No
Enumeration Date:2005-11-02
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15951363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS70166Medicare UPIN
CA0PA159510Medicare ID - Type Unspecified