Provider Demographics
NPI:1861436230
Name:ENCINAS, JANEL RAE (PA)
Entity type:Individual
Prefix:
First Name:JANEL
Middle Name:RAE
Last Name:ENCINAS
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:162-645-7660
Mailing Address - Fax:
Practice Address - Street 1:300 W HUNTINGTON DR
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3402
Practice Address - Country:US
Practice Address - Phone:626-574-3456
Practice Address - Fax:626-821-6927
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-16
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA18118363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA18118Medicaid
CAWPA18118BMedicare PIN
CAWPA18118AMedicare PIN