Provider Demographics
NPI:1104146836
Name:HAINOR, MARA ADRIANA (PA-C)
Entity type:Individual
Prefix:
First Name:MARA
Middle Name:ADRIANA
Last Name:HAINOR
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 RACE STREET
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95126-3518
Mailing Address - Country:US
Mailing Address - Phone:408-278-3000
Mailing Address - Fax:408-278-3692
Practice Address - Street 1:625 LINCOLN AVENUE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95126-3692
Practice Address - Country:US
Practice Address - Phone:408-278-3620
Practice Address - Fax:408-278-3692
Is Sole Proprietor?:No
Enumeration Date:2010-06-04
Last Update Date:2010-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA19737363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant