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General NPI Number Information
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NPI Number | 1821177254
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Entity Type | Individual
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Provider Name | SACHI LYNNE EZAKI PA-C
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Gender | Female
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Dates
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Enumeration Date | 11/05/2006
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Last Update Date | 10/22/2015
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Provider Practice Location Address
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Address Line | 147 W COLLEGE ST
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City | COVINA
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State | CA
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Zip | 91723-2008
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Country | US
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Telephone | 626-332-2860
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Fax | 626-967-3300
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Provider Business Mailing Address
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Address Line | 1232 CAMINO DEL SUR
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City | SAN DIMAS
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State | CA
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Zip | 91773-4404
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Country | US
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Telephone | 310-869-1465
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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 | PA 14712
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License Number State | CA
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