Student
NPI 1174079347ActiveOrganization· Physician Assistant· Redlands, CA
Physician Assistant in Redlands, California, registered in NPPES in August 2016. The authorized official on file is Cullen Mack, Student.
Overview
| NPI | 1174079347 |
|---|---|
| Status | Active |
| Entity type | Organization |
| NPI issued | Aug 28, 2016 |
| Last updated in NPPES | Aug 28, 2016 |
Specialties and licenses
| Taxonomy | Code | License | State |
|---|---|---|---|
| Physician Assistant Primary | 363A00000X | — | — |
Exclusion screening
| List | Result | Details |
|---|---|---|
| HHS-OIG LEIE · Oct 9, 2026 | No match | Checked by NPI and by name + state |
| North Carolina Medicaid · Nov 4, 2026 | No match | — |
| New York OMIG · Nov 4, 2026 | No match | — |
| Ohio Medicaid · Nov 4, 2026 | No match | — |
| Pennsylvania Medicheck · Nov 4, 2026 | No match | — |
| Washington HCA · Nov 4, 2026 | No match | — |
Official OIG search · How matching works ·Bulk check a roster
Medicare
| Enrollment (PECOS) | Not in the public enrollment file of Oct 1, 2026 |
|---|
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