Provider Demographics
NPI:1477342699
Name:SWISSA, NETHANIAL R (PA-S1)
Entity type:Individual
Prefix:MR
First Name:NETHANIAL
Middle Name:R
Last Name:SWISSA
Suffix:
Gender:M
Credentials:PA-S1
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9607 HILDRETH AVE
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-5205
Mailing Address - Country:US
Mailing Address - Phone:213-247-9175
Mailing Address - Fax:
Practice Address - Street 1:5850 E STILL CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3618
Practice Address - Country:US
Practice Address - Phone:213-247-9175
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant