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NPI Code Detail

MEDICARE: MEREDITH DETTMAR P.A.-C

MEDICARE: MEREDITH DETTMAR P.A.-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 Assistant52882CA
2363A00000XPhysician Assistant

General Provider Information

NPI Number : 1902275993
Entity Type Code : Individual
Provider Name (Legal Business Name) : MEREDITH DETTMAR P.A.-C
Provider Business Mailing Address
First Line : 16705 CAROB AVE
Second Line :
City : CHINO HILLS
State : CA
Zip : 91709-6524
Country : US
Telephone Number : 909-816-4256
Fax Number :
Provider Business Practice Location Address
First Line : 10787 LAUREL ST
Second Line :
City : RANCHO CUCAMONGA
State : CA
Zip : 91730-3828
Country : US
Telephone Number : 99-982-7741
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/19/2015
Last Update Date : 01/09/2024

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