Healthcare Provider Details

I. General information

NPI: 1083578546
Provider Name (Legal Business Name): CECILLE JOY RASGO CHAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CECILLE JOY DE JESUS RASGO

II. Dates (important events)

Enumeration Date: 12/10/2025
Last Update Date: 08/12/2026
Certification Date: 08/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SAN BERNARDINO RD STE 102
UPLAND CA
91786-4985
US

IV. Provider business mailing address

1310 SAN BERNARDINO RD STE 102
UPLAND CA
91786-4985
US

V. Phone/Fax

Practice location:
  • Phone: 909-608-2008
  • Fax:
Mailing address:
  • Phone: 909-608-2008
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number67978
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: