Provider Demographics
NPI:1831647387
Name:BALKCOM, SEAN (PA-C)
Entity Type:Individual
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First Name:SEAN
Middle Name:
Last Name:BALKCOM
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Gender:M
Credentials:PA-C
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Mailing Address - Street 1:255 E BONITA AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91767-1923
Mailing Address - Country:US
Mailing Address - Phone:909-593-7437
Mailing Address - Fax:909-593-0318
Practice Address - Street 1:255 E BONITA AVE STE 101
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91767-1923
Practice Address - Country:US
Practice Address - Phone:909-593-7437
Practice Address - Fax:909-593-0318
Is Sole Proprietor?:No
Enumeration Date:2016-09-13
Last Update Date:2020-02-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA53988363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant