Provider Demographics
NPI:1265418826
Name:PASQUINI, STEPHEN JACOB (PA)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:JACOB
Last Name:PASQUINI
Suffix:
Gender:
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:467 EL CAMINO REAL
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93927-4915
Mailing Address - Country:US
Mailing Address - Phone:831-674-0112
Mailing Address - Fax:831-674-4199
Practice Address - Street 1:115A CORAL ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95060-2131
Practice Address - Country:US
Practice Address - Phone:831-454-2080
Practice Address - Fax:831-454-3424
Is Sole Proprietor?:No
Enumeration Date:2005-12-15
Last Update Date:2025-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17531363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA175310Medicaid
CAQ31311Medicare UPIN
CA00PA175310Medicare ID - Type Unspecified