Provider Demographics
NPI:1700978970
Name:SILVA, MARIE LORIAN (PA)
Entity Type:Individual
Prefix:
First Name:MARIE
Middle Name:LORIAN
Last Name:SILVA
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 1:911 E TUOLUMNE RD
Mailing Address - Street 2:
Mailing Address - City:TURLOCK
Mailing Address - State:CA
Mailing Address - Zip Code:95382-1543
Mailing Address - Country:US
Mailing Address - Phone:209-656-9517
Mailing Address - Fax:209-656-9545
Practice Address - Street 1:1145 GEER RD
Practice Address - Street 2:SUITE A
Practice Address - City:TURLOCK
Practice Address - State:CA
Practice Address - Zip Code:95380-3381
Practice Address - Country:US
Practice Address - Phone:209-656-9517
Practice Address - Fax:209-656-9545
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-28
Last Update Date:2020-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA14183363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA141830Medicare ID - Type Unspecified