Provider Demographics
NPI:1396173621
Name:ABANIEL, REA ELIZABETH CRUZ (PA-C)
Entity type:Individual
Prefix:
First Name:REA ELIZABETH
Middle Name:CRUZ
Last Name:ABANIEL
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 1:944 BLUE HERON
Mailing Address - Street 2:
Mailing Address - City:SEAL BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90740-5612
Mailing Address - Country:US
Mailing Address - Phone:510-333-7835
Mailing Address - Fax:
Practice Address - Street 1:944 BLUE HERON
Practice Address - Street 2:
Practice Address - City:SEAL BEACH
Practice Address - State:CA
Practice Address - Zip Code:90740-5612
Practice Address - Country:US
Practice Address - Phone:510-333-7835
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-23
Last Update Date:2016-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22747363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant