Provider Demographics
NPI:1497560668
Name:CHARBONEAU, AVA MAGDALENE (PA-C)
Entity type:Individual
Prefix:
First Name:AVA
Middle Name:MAGDALENE
Last Name:CHARBONEAU
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2080 CENTURY PARK E STE 710
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90067-2010
Mailing Address - Country:US
Mailing Address - Phone:206-914-6892
Mailing Address - Fax:
Practice Address - Street 1:2080 CENTURY PARK E STE 710
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90067-2010
Practice Address - Country:US
Practice Address - Phone:310-715-3237
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-07-13
Deactivation Date:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant