Provider Demographics
NPI:1265648372
Name:HYTREK, SHERRY ROSE (PA-C)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:ROSE
Last Name:HYTREK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:6020 E. MARITA STREET
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90815
Mailing Address - Country:US
Mailing Address - Phone:562-598-7940
Mailing Address - Fax:562-933-8093
Practice Address - Street 1:2801 ATLANTIC AVE
Practice Address - Street 2:RANCH HOUSE #C
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90806-1701
Practice Address - Country:US
Practice Address - Phone:562-933-8590
Practice Address - Fax:562-933-8093
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2016-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11122363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant