Provider Demographics
NPI:1942524897
Name:MAR, HUGO GERARDO (PA)
Entity Type:Individual
Prefix:
First Name:HUGO
Middle Name:GERARDO
Last Name:MAR
Suffix:
Gender:M
Credentials:PA
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Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:284 PENNSYLVANIA DR
Mailing Address - Street 2:SUITE 1
Mailing Address - City:WATSONVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95076-3768
Mailing Address - Country:US
Mailing Address - Phone:831-722-8787
Mailing Address - Fax:831-722-8881
Practice Address - Street 1:284 PENNSYLVANIA DR
Practice Address - Street 2:SUITE 1
Practice Address - City:WATSONVILLE
Practice Address - State:CA
Practice Address - Zip Code:95076-3768
Practice Address - Country:US
Practice Address - Phone:831-722-8787
Practice Address - Fax:831-722-8881
Is Sole Proprietor?:No
Enumeration Date:2010-03-22
Last Update Date:2015-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA13256363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13256OtherLICENSE