Provider Demographics
NPI:1962912568
Name:AFFLALO, ADAM MICHAEL (PA-C)
Entity type:Individual
Prefix:
First Name:ADAM
Middle Name:MICHAEL
Last Name:AFFLALO
Suffix:
Gender:M
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 1:22 W 35TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:NATIONAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:91950-7926
Mailing Address - Country:US
Mailing Address - Phone:619-427-3361
Mailing Address - Fax:
Practice Address - Street 1:22 W 35TH ST STE 101
Practice Address - Street 2:
Practice Address - City:NATIONAL CITY
Practice Address - State:CA
Practice Address - Zip Code:91950-7926
Practice Address - Country:US
Practice Address - Phone:619-427-3361
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-09
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54958363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant