Provider Demographics
NPI:1912759150
Name:PAULINO, KARINA MERCEDES (PA)
Entity Type:Individual
Prefix:
First Name:KARINA
Middle Name:MERCEDES
Last Name:PAULINO
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 1:9224 S 168TH DR
Mailing Address - Street 2:
Mailing Address - City:GOODYEAR
Mailing Address - State:AZ
Mailing Address - Zip Code:85338-1493
Mailing Address - Country:US
Mailing Address - Phone:832-361-0736
Mailing Address - Fax:
Practice Address - Street 1:9224 S 168TH DR
Practice Address - Street 2:
Practice Address - City:GOODYEAR
Practice Address - State:AZ
Practice Address - Zip Code:85338-1493
Practice Address - Country:US
Practice Address - Phone:832-361-0736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-02
Last Update Date:2024-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ10318363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty