| Marijo Goodsite, PA | |
|
400 N Pepper Ave, Colton, CA 92324-1801 | |
| (909) 580-1000 | |
| Not Available |
| Full Name | Marijo Goodsite |
|---|---|
| Gender | Female |
| Speciality | Physician Assistant - Medical |
| Location | 400 N Pepper Ave, Colton, California |
| Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619229564 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 363AM0700X | Physician Assistant - Medical | (* (Not Available)) | Primary |
| Entity Name | Main Line Emergency Med Associates LLC |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1316919368 PECOS PAC ID: 9234034729 Enrollment ID: O20031208000122 |
| Mailing Address | Practice Location Address |
|---|---|
| Marijo Goodsite, PA 134 Greenwood Hts, Bellevue, OH 44811-1049 Ph: (419) 217-0061 | Marijo Goodsite, PA 400 N Pepper Ave, Colton, CA 92324-1801 Ph: (909) 580-1000 |
Richard Anthony Benavidez, PA Physician Assistant Medicare: Medicare Enrolled Practice Location: 400 N Pepper Ave, Colton, CA 92324 Phone: 909-580-1000 |
Tiffany Jackie Hwang, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 400 N Pepper Ave # 205, Colton, CA 92324 Phone: 909-331-9598 |
Lawrence David Gates, P.A-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 400 N. Pepper Avenue, Colton, CA 92324 Phone: 909-580-1400 |
Mrs. Amy Elizabeth Dahlberg, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 400 N Pepper Ave, Colton, CA 92324 Phone: 909-354-2195 |
Olivia Sophia Zetty, PA-C Physician Assistant Medicare: Not Enrolled in Medicare Practice Location: 400 N Pepper Ave Ste 2m206, Colton, CA 92324 Phone: 317-900-3912 |
Brian Kent Heaton, Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 400 N Pepper Ave, Colton, CA 92324 Phone: 909-580-3390 |
Emma Werner Oliver, PA-C Physician Assistant Medicare: Accepting Medicare Assignments Practice Location: 400 N Pepper Ave, Colton, CA 92324 Phone: 909-580-1000 |