Provider Demographics
NPI:1720245699
Name:NG, NETTIE (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:NETTIE
Middle Name:
Last Name:NG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:455 OCONNOR DR
Mailing Address - Street 2:SUITE 290
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-1633
Mailing Address - Country:US
Mailing Address - Phone:408-998-5400
Mailing Address - Fax:408-998-5414
Practice Address - Street 1:455 OCONNOR DR
Practice Address - Street 2:SUITE 290
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-1633
Practice Address - Country:US
Practice Address - Phone:408-998-5400
Practice Address - Fax:408-998-5414
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2013-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19678363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA19678OtherCALIFORNIA LICENSE