Provider Demographics
NPI:1225369333
Name:IGLESIAS, ALICIA (MS, PA-C)
Entity type:Individual
Prefix:
First Name:ALICIA
Middle Name:
Last Name:IGLESIAS
Suffix:
Gender:F
Credentials:MS, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3301 W THORNTON AVE
Mailing Address - Street 2:
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92804-4714
Mailing Address - Country:US
Mailing Address - Phone:714-270-4712
Mailing Address - Fax:
Practice Address - Street 1:9939 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-3528
Practice Address - Country:US
Practice Address - Phone:951-687-8802
Practice Address - Fax:951-687-2250
Is Sole Proprietor?:No
Enumeration Date:2010-01-29
Last Update Date:2010-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20551363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAGR0083640-GR0083641OtherMEDICAL GROUP
CAZZZ19972Z-ZZZ20075ZOtherMEDICARE GROUP