Provider Demographics
NPI:1043339831
Name:PAIVA, WENDY (PA-C)
Entity type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:PAIVA
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:24422 AVENIDA DE LA CARLOTA STE 300
Mailing Address - Street 2:
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-3628
Mailing Address - Country:US
Mailing Address - Phone:959-599-2434
Mailing Address - Fax:
Practice Address - Street 1:13601 CENTRAL AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710
Practice Address - Country:US
Practice Address - Phone:909-627-6076
Practice Address - Fax:909-395-9787
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA15584363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant