Provider Demographics
NPI:1376197590
Name:MASTROSERIO, ILARIA OLIVER (PA-C)
Entity type:Individual
Prefix:
First Name:ILARIA
Middle Name:OLIVER
Last Name:MASTROSERIO
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:1450 TREAT BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94597-2168
Mailing Address - Country:US
Mailing Address - Phone:925-952-2828
Mailing Address - Fax:
Practice Address - Street 1:177 LA CASA VIA STE 390
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-6101
Practice Address - Country:US
Practice Address - Phone:925-692-5610
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-07-25
Last Update Date:2024-05-22
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant