Provider Demographics
NPI:1679063945
Name:SIA, WILLIAM A (NP-C)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:A
Last Name:SIA
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1365 WICKHAM CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIMAS
Mailing Address - State:CA
Mailing Address - Zip Code:91773-3862
Mailing Address - Country:US
Mailing Address - Phone:626-261-3175
Mailing Address - Fax:
Practice Address - Street 1:1382 E FOOTHILL BLVD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-4014
Practice Address - Country:US
Practice Address - Phone:909-982-6500
Practice Address - Fax:909-920-0406
Is Sole Proprietor?:No
Enumeration Date:2018-05-13
Last Update Date:2019-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAF03180293363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily