Provider Demographics
NPI:1679683239
Name:ONYSKO, RICHARD HARRY (PA)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:HARRY
Last Name:ONYSKO
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:55 E CALIFORNIA BLVD
Mailing Address - Street 2:3RD FL
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105
Mailing Address - Country:US
Mailing Address - Phone:626-793-1227
Mailing Address - Fax:626-793-3794
Practice Address - Street 1:301 W HUNTINGTON DR
Practice Address - Street 2:ST 500
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3462
Practice Address - Country:US
Practice Address - Phone:626-294-4880
Practice Address - Fax:626-294-4888
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2015-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA11608363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA11608OtherSTATE LIC
CAPA11608OtherSTATE LIC
R40333Medicare UPIN