Provider Demographics
NPI:1669873584
Name:MUSTEDANAGIC, MERDINA (PA-C)
Entity type:Individual
Prefix:MISS
First Name:MERDINA
Middle Name:
Last Name:MUSTEDANAGIC
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 1:257 W FAIRVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:CA
Mailing Address - Zip Code:91202-3706
Mailing Address - Country:US
Mailing Address - Phone:423-316-1184
Mailing Address - Fax:
Practice Address - Street 1:260 E HOLT AVE
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-5426
Practice Address - Country:US
Practice Address - Phone:909-629-8088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-10
Last Update Date:2014-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51893363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant