Provider Demographics
NPI:1093720666
Name:LOA, HEDY CECILIA (MD)
Entity Type:Individual
Prefix:
First Name:HEDY
Middle Name:CECILIA
Last Name:LOA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:840 TOWNE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-5900
Mailing Address - Country:US
Mailing Address - Phone:909-398-1550
Mailing Address - Fax:909-618-1190
Practice Address - Street 1:1131 W 6TH ST STE 150
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-1116
Practice Address - Country:US
Practice Address - Phone:909-482-4462
Practice Address - Fax:909-482-4485
Is Sole Proprietor?:No
Enumeration Date:2006-07-30
Last Update Date:2023-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA38337207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A383370Medicaid
CA00A383370Medicaid
A28596Medicare UPIN