Provider Demographics
NPI:1992997217
Name:CAPARAS, MARIA JEFFERVESCENT MATINING (PA-C)
Entity type:Individual
Prefix:
First Name:MARIA JEFFERVESCENT
Middle Name:MATINING
Last Name:CAPARAS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:MARY JEFFERVESCENT
Other - Middle Name:MATINING
Other - Last Name:CAPARAS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PA
Mailing Address - Street 1:6195 LUSK BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92121-3715
Mailing Address - Country:US
Mailing Address - Phone:480-307-4693
Mailing Address - Fax:
Practice Address - Street 1:6195 LUSK BLVD STE 250
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92121-3715
Practice Address - Country:US
Practice Address - Phone:480-307-4693
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-10
Last Update Date:2022-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZPA3454363A00000X
CAPA17154363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ122701Medicare PIN