Provider Demographics
NPI:1184802332
Name:NEWMAN, NICOLE RAE (PA-C)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:RAE
Last Name:NEWMAN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2250 S MAIN ST
Mailing Address - Street 2:STE. 106
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-2534
Mailing Address - Country:US
Mailing Address - Phone:951-371-2703
Mailing Address - Fax:951-739-6150
Practice Address - Street 1:2250 S MAIN ST
Practice Address - Street 2:STE. 106
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-2534
Practice Address - Country:US
Practice Address - Phone:951-371-2703
Practice Address - Fax:951-739-6150
Is Sole Proprietor?:No
Enumeration Date:2008-02-08
Last Update Date:2013-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA16035363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant