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:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1431 S SHERBOURNE DR APT 2
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90035-3598
Mailing Address - Country:US
Mailing Address - Phone:206-914-6892
Mailing Address - Fax:
Practice Address - Street 1:9401 JERONIMO RD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-1908
Practice Address - Country:US
Practice Address - Phone:714-744-7650
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-02-12
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant