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General NPI Number Information
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NPI Number | 1740028901
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Entity Type | Individual
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Provider Name | THEZIA SYLVIANA PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/19/2024
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Last Update Date | 12/11/2024
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Provider Practice Location Address
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Address Line | 599 INLAND CENTER DR STE 105
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City | SAN BERNARDINO
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State | CA
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Zip | 92408-1854
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Country | US
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Telephone | 909-889-2665
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Fax | 909-884-4114
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Provider Business Mailing Address
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Address Line | 309 E 2ND ST
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City | POMONA
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State | CA
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Zip | 91766-1854
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA65119
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License Number State | CA
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