Provider Demographics
NPI:1760622179
Name:XIONG, PA C (SRNA)
Entity Type:Individual
Prefix:
First Name:PA
Middle Name:C
Last Name:XIONG
Suffix:
Gender:F
Credentials:SRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2780 E BIG RANGE RD
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-9100
Mailing Address - Country:US
Mailing Address - Phone:909-659-7831
Mailing Address - Fax:
Practice Address - Street 1:2780 E BIG RANGE RD
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-9100
Practice Address - Country:US
Practice Address - Phone:909-659-7831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-02-24
Last Update Date:2021-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA535902164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse