Provider Demographics
NPI:1164560264
Name:EYONG, PHILOMINA (PA)
Entity Type:Individual
Prefix:
First Name:PHILOMINA
Middle Name:
Last Name:EYONG
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 PEPPERWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-4742
Mailing Address - Country:US
Mailing Address - Phone:909-622-7933
Mailing Address - Fax:
Practice Address - Street 1:1711 OCEAN PARK BLVD
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90405-4901
Practice Address - Country:US
Practice Address - Phone:310-450-2191
Practice Address - Fax:310-450-0873
Is Sole Proprietor?:No
Enumeration Date:2007-02-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALPA 13728363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA 13728Medicare ID - Type UnspecifiedPHYSICIAN ASSISTANT