Provider Demographics
NPI:1669573911
Name:STRAIN, ANN (PA)
Entity type:Individual
Prefix:
First Name:ANN
Middle Name:
Last Name:STRAIN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 EL CAMINO REAL
Mailing Address - Street 2:SUITE 301
Mailing Address - City:BURLINGAME
Mailing Address - State:CA
Mailing Address - Zip Code:94010-3127
Mailing Address - Country:US
Mailing Address - Phone:650-552-8100
Mailing Address - Fax:650-552-8105
Practice Address - Street 1:1860 EL CAMINO REAL
Practice Address - Street 2:SUITE 301
Practice Address - City:BURLINGAME
Practice Address - State:CA
Practice Address - Zip Code:94010-3127
Practice Address - Country:US
Practice Address - Phone:650-552-8100
Practice Address - Fax:650-552-8105
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2015-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13468363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA136460Medicaid
S52889Medicare UPIN
0PA136460Medicare ID - Type Unspecified