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1135 S Sunset Ave Ste 100 West Covina CA 91790-3938 | |
| (626) 960-8614 | |
| (626) 960-8624 |
| Full Name | |
|---|---|
| Speciality | Physician Assistant |
| Location | 1135 S Sunset Ave Ste 100, West Covina, California |
| Authorized Official Name and Position | Laura Longley (COO) |
| Authorized Official Contact | 6269608614 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1135 S Sunset Ave Ste 100 West Covina CA 91790-3938 Ph: (626) 960-8614 | 1135 S Sunset Ave Ste 100 West Covina CA 91790-3938 Ph: (626) 960-8614 |
| NPI Number | 1366532814 |
|---|---|
| Provider Enumeration Date | 10/13/2006 |
| Last Update Date | 08/22/2020 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1366532814 | NPI | - | NPPES |
| ZZZ32579Z | Other | CA | MEDICAL |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | (* (Not Available)) | Primary |
| 2085R0202X | Radiology - Diagnostic Radiology | (California) | Primary |
| 363A00000X | Physician Assistant | (California) | Primary |
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