Provider Demographics
NPI:1962784025
Name:NACCARTO-COLEMAN, AMELIA (PA-C)
Entity type:Individual
Prefix:MRS
First Name:AMELIA
Middle Name:
Last Name:NACCARTO-COLEMAN
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 1:218 W MAIN ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-7719
Mailing Address - Country:US
Mailing Address - Phone:949-466-4633
Mailing Address - Fax:949-551-1327
Practice Address - Street 1:218 W MAIN ST
Practice Address - Street 2:SUITE 103
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92780-7719
Practice Address - Country:US
Practice Address - Phone:949-466-4633
Practice Address - Fax:949-551-1327
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-15
Last Update Date:2011-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12082363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant