Provider Demographics
NPI:1851307219
Name:ADUCAYEN, PACITA R (MD)
Entity Type:Individual
Prefix:DR
First Name:PACITA
Middle Name:R
Last Name:ADUCAYEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 GLADSTONE DR STE 2
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:CA
Mailing Address - Zip Code:94565-5124
Mailing Address - Country:US
Mailing Address - Phone:925-432-6208
Mailing Address - Fax:925-432-0134
Practice Address - Street 1:2250 GLADSTONE DR STE 2
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:CA
Practice Address - Zip Code:94565-5124
Practice Address - Country:US
Practice Address - Phone:925-432-6208
Practice Address - Fax:925-432-0134
Is Sole Proprietor?:No
Enumeration Date:2006-07-31
Last Update Date:2023-10-13
Deactivation Date:2013-01-03
Deactivation Code:
Reactivation Date:2013-01-15
Provider Licenses
StateLicense IDTaxonomies
CAA049795207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA05D1059200OtherCLIA CERTIFICATION
CA05D1059200OtherCLIA CERTIFICATION