Provider Demographics
NPI:1003357955
Name:HOMAYONI, SEPIDEH (PA-C)
Entity Type:Individual
Prefix:
First Name:SEPIDEH
Middle Name:
Last Name:HOMAYONI
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:SEPIDEH
Other - Middle Name:
Other - Last Name:HOMAYONINEJAD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3281 E GUASTI RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7622
Mailing Address - Country:US
Mailing Address - Phone:909-295-7073
Mailing Address - Fax:
Practice Address - Street 1:3281 E GUASTI RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7622
Practice Address - Country:US
Practice Address - Phone:909-295-7073
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-12
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54279363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant