Provider Demographics
NPI:1659829513
Name:MUSSELMAN, GREGORY J (PA-C)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:J
Last Name:MUSSELMAN
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 1:3550 E PHILADELPHIA ST STE 150
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-2963
Mailing Address - Country:US
Mailing Address - Phone:909-781-6015
Mailing Address - Fax:
Practice Address - Street 1:3550 E PHILADELPHIA ST STE 150
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761
Practice Address - Country:US
Practice Address - Phone:909-773-0022
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-09-20
Last Update Date:2018-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical