Provider Demographics
NPI:1154331189
Name:HARVEY, MARK C (PA-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:C
Last Name:HARVEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:771 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:DIAMOND BAR
Mailing Address - State:CA
Mailing Address - Zip Code:91765-6105
Mailing Address - Country:US
Mailing Address - Phone:909-396-0050
Mailing Address - Fax:
Practice Address - Street 1:14726 RAMONA AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5730
Practice Address - Country:US
Practice Address - Phone:909-393-7222
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12278363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant