Healthcare Provider Details

I. General information

NPI: 1972511319
Provider Name (Legal Business Name): DIONNE LASHON HENDERSON PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2006
Last Update Date: 08/21/2026
Certification Date: 08/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20920 CHICO ST
CARSON CA
90746-3603
US

IV. Provider business mailing address

2881 PARK VISTA CT
FULLERTON CA
92835-2903
US

V. Phone/Fax

Practice location:
  • Phone: 424-333-9151
  • Fax: 833-973-3630
Mailing address:
  • Phone: 562-746-3950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA18290
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: