Healthcare Provider Details

I. General information

NPI: 1306074802
Provider Name (Legal Business Name): EMMANUEL SAWAYA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

403 W F ST
ONTARIO CA
91762-3207
US

IV. Provider business mailing address

403 W F ST
ONTARIO CA
91762-3207
US

V. Phone/Fax

Practice location:
  • Phone: 909-988-3288
  • Fax: 909-988-6767
Mailing address:
  • Phone: 909-988-3288
  • Fax: 909-988-6767

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA20007
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: