Mayra Alexandra Peng, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

23217 Issued in CA

Practice address

1515 E Ocean Ave
Lompoc, CA 93436-7092

Phone

(805) 737-3300

NPI assigned

Oct 4, 2013

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Pacific Professional Surgical Group Inc

  • Trauma Surgery Physician
  • Riverside, CA
  • NPI 1578341608
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1380844800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1607558400000",
    "number": "1366879306",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1515 E OCEAN AVE",
            "city": "LOMPOC",
            "state": "CA",
            "postal_code": "934367092",
            "telephone_number": "805-737-3300"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1515 E OCEAN AVE",
            "city": "LOMPOC",
            "state": "CA",
            "postal_code": "934367092",
            "telephone_number": "805-737-3300"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "4234 Riverwalk Pkwy. Suite 230",
            "address_2": "Pacific Pulmonary Medical Group",
            "address_purpose": "LOCATION",
            "city": "Riverside",
            "state": "CA",
            "postal_code": "92505",
            "country_code": "US",
            "telephone_number": "951-781-3672",
            "fax_number": "951-781-0365",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "1102 W 32nd St Ste 200",
            "address_purpose": "LOCATION",
            "city": "Joplin",
            "state": "MO",
            "postal_code": "648043503",
            "country_code": "US",
            "telephone_number": "417-347-5001",
            "fax_number": "417-347-2477",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PENG",
        "first_name": "MAYRA",
        "middle_name": "ALEXANDRA",
        "name_prefix": "Ms.",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2013-10-04",
        "last_updated": "2020-12-10",
        "certification_date": "2020-12-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MO",
            "license": "2017041798",
            "primary": false
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "23217",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karen Pata, RD
• Path to Peace, a Licensed Clinical Social Worker, P.C.
• Katrina Payne
• Izayah Tristan Pedroza
• Alejandro Pena
• Antonio Nevarez Penuelas Jr.
• Cynthia Pereira
• Luvinia Johanna Perez
• Nancy Perez
• Hadisha Person, LMFT

• Physician Assistant in Lompoc, CA
• Providers in Lompoc, CA by specialty
• Physician Assistant in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 10, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.