Provider Demographics
NPI:1356582654
Name:ORIBELLO, MARK (PA-C, MPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:ORIBELLO
Suffix:
Gender:M
Credentials:PA-C, MPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:101 BODIN CIRCLE, TRAVIS AFB
Mailing Address - Street 2:
Mailing Address - City:TRAVIS
Mailing Address - State:CA
Mailing Address - Zip Code:94535-1800
Mailing Address - Country:US
Mailing Address - Phone:408-313-0173
Mailing Address - Fax:
Practice Address - Street 1:101 BODIN CIRCLE, TRAVIS AFB
Practice Address - Street 2:
Practice Address - City:TRAVIS
Practice Address - State:CA
Practice Address - Zip Code:94535-1800
Practice Address - Country:US
Practice Address - Phone:408-313-0173
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-16
Last Update Date:2016-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19313363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant