Provider Demographics
NPI:1689860082
Name:COLEMAN, SEAN FITZGERALD (PA-C)
Entity Type:Individual
Prefix:MR
First Name:SEAN
Middle Name:FITZGERALD
Last Name:COLEMAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Mailing Address - Street 1:9055 SAN SIMEON DR
Mailing Address - Street 2:
Mailing Address - City:ALTA LOMA
Mailing Address - State:CA
Mailing Address - Zip Code:91701-6603
Mailing Address - Country:US
Mailing Address - Phone:909-476-3797
Mailing Address - Fax:909-476-3797
Practice Address - Street 1:14726 RAMONA AVE STE AND107
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5730
Practice Address - Country:US
Practice Address - Phone:909-393-7322
Practice Address - Fax:310-343-6040
Is Sole Proprietor?:No
Enumeration Date:2007-09-19
Last Update Date:2007-09-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA12845363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical