Provider Demographics
NPI:1851583553
Name:BIANCO, KATHY (PA)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:BIANCO
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 1:41210 11TH ST W
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-1447
Mailing Address - Country:US
Mailing Address - Phone:661-947-7100
Mailing Address - Fax:661-947-2211
Practice Address - Street 1:41210 11TH ST W
Practice Address - Street 2:STE.C
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-1447
Practice Address - Country:US
Practice Address - Phone:661-947-7100
Practice Address - Fax:661-947-2211
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-16
Last Update Date:2007-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17139363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAWPA17139AMedicare UPIN