Provider Demographics
NPI:1962633180
Name:HUGHES, MARY BETH (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:MS
First Name:MARY
Middle Name:BETH
Last Name:HUGHES
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:311 N ROBERTSON BLVD
Mailing Address - Street 2:#191
Mailing Address - City:BEVERLY HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:90211-1705
Mailing Address - Country:US
Mailing Address - Phone:626-337-3770
Mailing Address - Fax:
Practice Address - Street 1:311 N ROBERTSON BLVD
Practice Address - Street 2:#191
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-1705
Practice Address - Country:US
Practice Address - Phone:626-337-3770
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20418367A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAMH2337853OtherDEA
CA2254536Medicare UPIN