Healthcare Provider Details

I. General information

NPI: 1245548874
Provider Name (Legal Business Name): CYNTHIA HOANG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2010
Last Update Date: 07/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

795 E 2ND ST STE 5
POMONA CA
91766
US

IV. Provider business mailing address

795 E 2ND ST STE 5
POMONA CA
91766-2007
US

V. Phone/Fax

Practice location:
  • Phone: 909-865-2565
  • Fax: 909-865-2955
Mailing address:
  • Phone: 909-865-2565
  • Fax: 909-865-2955

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number21122
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: