Healthcare Provider Details

I. General information

NPI: 1871712034
Provider Name (Legal Business Name): EPHRAIM LITONJUA SANMIGUEL JR. P.A.C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/25/2007
Last Update Date: 11/30/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2295 S VINEYARD AVE BLDG A PRIMARY CARE 2ND FLOOR
ONTARIO CA
91761-7925
US

IV. Provider business mailing address

2295 S VINEYARD AVE BLDG A PRIMARY CARE 2ND FLOOR
ONTARIO CA
91761-7925
US

V. Phone/Fax

Practice location:
  • Phone: 888-750-0036
  • Fax: 909-264-2266
Mailing address:
  • Phone: 888-750-0036
  • Fax: 909-264-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA13252
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: