Provider Demographics
NPI:1003380593
Name:KINZER, IRYNA (PA-C)
Entity Type:Individual
Prefix:
First Name:IRYNA
Middle Name:
Last Name:KINZER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:IRYNA
Other - Middle Name:
Other - Last Name:KHLEBNIKAVA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 534
Mailing Address - Street 2:
Mailing Address - City:LAKE ARROWHEAD
Mailing Address - State:CA
Mailing Address - Zip Code:92352-0534
Mailing Address - Country:US
Mailing Address - Phone:909-503-2311
Mailing Address - Fax:
Practice Address - Street 1:255 TERRACINA BLVD STE 205C
Practice Address - Street 2:
Practice Address - City:REDLANDS
Practice Address - State:CA
Practice Address - Zip Code:92373-4870
Practice Address - Country:US
Practice Address - Phone:909-793-2323
Practice Address - Fax:909-793-2324
Is Sole Proprietor?:No
Enumeration Date:2019-01-17
Last Update Date:2019-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA55507363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant