Provider Demographics
NPI:1891058640
Name:YAGNIK, AISHWARYA (PA-C)
Entity Type:Individual
Prefix:
First Name:AISHWARYA
Middle Name:
Last Name:YAGNIK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:AISHWARYA
Other - Middle Name:
Other - Last Name:VARADHARAJAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:27300 IRIS AVE
Mailing Address - Street 2:
Mailing Address - City:MORENO VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92555-4802
Mailing Address - Country:US
Mailing Address - Phone:951-243-0811
Mailing Address - Fax:951-243-2075
Practice Address - Street 1:27300 IRIS AVE
Practice Address - Street 2:
Practice Address - City:MORENO VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92555-4802
Practice Address - Country:US
Practice Address - Phone:951-243-0811
Practice Address - Fax:951-243-2075
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2020-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23116363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA23116OtherPHYSICIAN ASSISTANT BOARD