Provider Demographics
NPI:1841536208
Name:SKULSKY, EVA JUDITH (PA, MPAS)
Entity type:Individual
Prefix:
First Name:EVA
Middle Name:JUDITH
Last Name:SKULSKY
Suffix:
Gender:F
Credentials:PA, MPAS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3923 WARING RD STE A
Mailing Address - Street 2:
Mailing Address - City:OCEANSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92056-4499
Mailing Address - Country:US
Mailing Address - Phone:760-727-8782
Mailing Address - Fax:760-842-7801
Practice Address - Street 1:3923 WARING RD STE A
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:CA
Practice Address - Zip Code:92056-4499
Practice Address - Country:US
Practice Address - Phone:760-727-8782
Practice Address - Fax:760-842-7801
Is Sole Proprietor?:No
Enumeration Date:2012-12-12
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17593363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1841536208Medicaid