MEDICARE: MR. BRIAN KEITH HUGHES P.A.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363AM0700X	Medical Physician Assistant	PA16729	CA

General Provider Information

NPI Number	:	1760621890
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. BRIAN KEITH HUGHES P.A.

Provider Business Mailing Address
First Line	:	840 TOWNE CENTER DR
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91767-5900
Country	:	US
Telephone Number	:	909-398-1550
Fax Number	:	909-398-1488

Provider Business Practice Location Address
First Line	:	297 W ARTESIA ST STE A
Second Line	:
City	:	POMONA
State	:	CA
Zip	:	91768-1808
Country	:	US
Telephone Number	:	909-623-1503
Fax Number	:	909-623-8061

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/12/2009
Last Update Date	:	09/12/2018

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