Provider Demographics
NPI:1447491980
Name:ALSISTO-PAGATPATAN, RENEE PAGAL (PA-C)
Entity type:Individual
Prefix:MRS
First Name:RENEE
Middle Name:PAGAL
Last Name:ALSISTO-PAGATPATAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MS
Other - First Name:RENEE
Other - Middle Name:PAGAL
Other - Last Name:ALSISTO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:1339 W. WILLOW STREET
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90810
Mailing Address - Country:US
Mailing Address - Phone:562-492-6698
Mailing Address - Fax:562-492-9553
Practice Address - Street 1:1339 W. WILLOW STREET
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90810
Practice Address - Country:US
Practice Address - Phone:562-492-6698
Practice Address - Fax:562-492-9553
Is Sole Proprietor?:No
Enumeration Date:2009-03-12
Last Update Date:2011-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA17501363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA17501OtherCA PA COMMITTEE
CAPA17501OtherPA CA LICENSE NUMBER