Provider Demographics
NPI:1275886715
Name:KORCEK, ASHLENE JANIECE (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:ASHLENE
Middle Name:JANIECE
Last Name:KORCEK
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:ASHLENE
Other - Middle Name:JANIECE
Other - Last Name:COOK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:26121 MERRILL PL
Mailing Address - Street 2:
Mailing Address - City:LOMA LINDA
Mailing Address - State:CA
Mailing Address - Zip Code:92354-4136
Mailing Address - Country:US
Mailing Address - Phone:503-806-5594
Mailing Address - Fax:
Practice Address - Street 1:2301 E FOOTHILL BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:GLENDORA
Practice Address - State:CA
Practice Address - Zip Code:91740-4000
Practice Address - Country:US
Practice Address - Phone:626-852-3376
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-22
Last Update Date:2013-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA22645363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant