Provider Demographics
NPI:1285794982
Name:MAGUIRE, AIDAN C (PA)
Entity type:Individual
Prefix:MR
First Name:AIDAN
Middle Name:C
Last Name:MAGUIRE
Suffix:
Gender:M
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:PO BOX 45680
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94145-0680
Mailing Address - Country:US
Mailing Address - Phone:530-626-3682
Mailing Address - Fax:
Practice Address - Street 1:3581 PALMER DR
Practice Address - Street 2:STE. 401
Practice Address - City:CAMERON PARK
Practice Address - State:CA
Practice Address - Zip Code:95682-8236
Practice Address - Country:US
Practice Address - Phone:530-676-7337
Practice Address - Fax:530-676-1141
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16310363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA16310OtherLICENSE #
CAMM1358301OtherDEA NUMBER