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Physician Assistants & Advanced Practice Nursing Providers Physician Assistant

Provider NPI: 1164643250

Provider Information:
Gender: F
Sole Proprietor

Practice Location:
2720 N HARBOR BLVD 130 FULLERTON, CA 92835-2609 US
Tel: 714-449-6200  Fax: 714-449-1773

Business Mailing Address:
2720 N HARBOR BLVD 130 FULLERTON, CA 92835-2609 US
Tel: 714-449-6200  Fax: 714-449-1773

NPI Information:
NPI: 1164643250
Entity Type: Individual


PrimaryCodeCategory/DescriptionStateLicense Number
Y363A00000XPhysician Assistants & Advanced Practice Nursing Providers
Physician Assistant

Other Provider Identifiers:


American Medical Association 2012 taxonomy code information

Code: 363A00000X





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