Individual
MISS AROUNRATSAMI SAKOUNPHONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
1574 W BASE LINE ST STE 107, SAN BERNARDINO, CA 92411-1736
(909) 386-1880
(909) 386-1882
Mailing address
1571 W SUNSET BLVD, LOS ANGELES, CA 90026-3333
(213) 482-4400
(213) 482-5150
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA16271
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
PA16271
—
CA
Enumeration date
07/20/2006
Last updated
09/18/2019
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