Provider Demographics
NPI:1922320407
Name:MAESE, PABLO MATEO (PA-C)
Entity Type:Individual
Prefix:MR
First Name:PABLO
Middle Name:MATEO
Last Name:MAESE
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38600 MEDICAL CENTER DR
Mailing Address - Street 2:
Mailing Address - City:PALMDALE
Mailing Address - State:CA
Mailing Address - Zip Code:93551-4483
Mailing Address - Country:US
Mailing Address - Phone:661-382-6000
Mailing Address - Fax:
Practice Address - Street 1:38600 MEDICAL CENTER DR
Practice Address - Street 2:
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93551-4483
Practice Address - Country:US
Practice Address - Phone:661-382-6000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-02-24
Last Update Date:2014-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMPA2011-0016363A00000X
UT7593560-1206363A00000X
CAPA21071363A00000X
WAPA60299193363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant