Provider Demographics
NPI:1790284131
Name:EASTON, SEAN (PA)
Entity Type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:EASTON
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:145 THUNDER DR
Mailing Address - Street 2:
Mailing Address - City:VISTA
Mailing Address - State:CA
Mailing Address - Zip Code:92083-6010
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:760-805-0421
Practice Address - Street 1:145 THUNDER DR
Practice Address - Street 2:
Practice Address - City:VISTA
Practice Address - State:CA
Practice Address - Zip Code:92083-6010
Practice Address - Country:US
Practice Address - Phone:760-941-9002
Practice Address - Fax:760-805-0421
Is Sole Proprietor?:No
Enumeration Date:2018-02-11
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ6981OtherSTATE LICENSE
CA58687OtherSTATE LICENSE