Provider Demographics
NPI:1053145698
Name:CA PHYSICIAN ASSISTANT COOPERATIVE HEALTHCARE, PC
Entity type:Organization
Organization Name:CA PHYSICIAN ASSISTANT COOPERATIVE HEALTHCARE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:ASHBY
Authorized Official - Suffix:
Authorized Official - Credentials:PA
Authorized Official - Phone:818-968-4242
Mailing Address - Street 1:645 AERICK ST STE 3
Mailing Address - Street 2:
Mailing Address - City:INGLEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90301-4884
Mailing Address - Country:US
Mailing Address - Phone:310-431-4926
Mailing Address - Fax:
Practice Address - Street 1:645 AERICK ST STE 3
Practice Address - Street 2:
Practice Address - City:INGLEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90301-4884
Practice Address - Country:US
Practice Address - Phone:310-431-4926
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty