Henderson Surgical Physician Assistant
Physician Assistant, Surgical in Riverside, CA. Organization (NPI-2).
NPI number1982129342
StatusActive
Last updated in NPPESAug 7, 2017
Details
- NPI
- 1982129342
- Entity type
- Organization (NPI-2)
- Legal business name
- Henderson Surgical Physician Assistant
- Organization subpart
- No
- Enumeration date
- Aug 7, 2017
- Last updated
- Aug 7, 2017
Taxonomy and licenses
| Taxonomy code | Description | License | State | Primary |
|---|---|---|---|---|
| 363AS0400X | Physician Assistant, Surgical | 51407 | CA | Yes |
Practice location
4445 Magnolia AveRiverside, CA 92501-4135
Phone 951-443-9606
Mailing address
12625 Frederick St # I5215Moreno Valley, CA 92553-5216
Phone 951-443-9606
Authorized official
Sofia Henderson
President
9514439606
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