Individual provider · NPI-1

Sean Balkcom, PA-C

Physician Assistant · Pomona, CA

NPI number1831647387
StatusActive
Last updated in NPPESFeb 7, 2020

Details

NPI
1831647387
Entity type
Individual (NPI-1)
Name
Sean Balkcom
Credential
PA-C
Sex
Male
Sole proprietor
No
Enumeration date
Sep 13, 2016
Certification date
Feb 7, 2020
Last updated
Feb 7, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
363A00000X Physician Assistant53988CAYes

Practice location

255 E Bonita Ave Ste 101
Pomona, CA 91767-1923

Phone 909-593-7437 · Fax 909-593-0318

Mailing address

255 E Bonita Ave Ste 101
Pomona, CA 91767-1923

Phone 909-593-7437 · Fax 909-593-0318

Other practice locations

7777a Milliken Ave Ste 101
Rancho Cucamonga, CA 91730-6778

Phone 909-593-7437 · Fax 909-593-0318

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