Provider Demographics
NPI:1194745661
Name:LECAIR, ANETTE J (PA-C)
Entity type:Individual
Prefix:MRS
First Name:ANETTE
Middle Name:J
Last Name:LECAIR
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 1:770 MAGNOLIA AVE STE 1H
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-3121
Mailing Address - Country:US
Mailing Address - Phone:951-734-8989
Mailing Address - Fax:951-734-8998
Practice Address - Street 1:770 MAGNOLIA AVE STE 1H
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3121
Practice Address - Country:US
Practice Address - Phone:951-734-8989
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-20
Last Update Date:2018-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA13311363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00067816OtherRR MEDICARE
CAP00067816OtherRR MEDICARE
CA0PA133110Medicare ID - Type Unspecified