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NPI Code Detail

MEDICARE: MR. ERIC SONG PA-C

MEDICARE: MR. ERIC SONG PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363A00000XPhysician AssistantPA21386CA

General Provider Information

NPI Number : 1083918403
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. ERIC SONG PA-C
Provider Business Mailing Address
First Line : 1850 E WASHINGTON ST
Second Line :
City : COLTON
State : CA
Zip : 92324-4621
Country : US
Telephone Number : 909-887-2991
Fax Number :
Provider Business Practice Location Address
First Line : 1850 E WASHINGTON ST
Second Line :
City : COLTON
State : CA
Zip : 92324-4621
Country : US
Telephone Number : 909-887-2991
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/28/2010
Last Update Date : 07/18/2023

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Directions to “ MR. ERIC SONG PA-C” Practice Location

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