Individual
MR. DIEGO H SEVILLA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHYSICIAN ASSISTANT
Contact information
Practice address
436 S RIVERSIDE AVE, RIALTO, CA 92376-6523
(909) 877-8868
(909) 877-0008
Mailing address
436 S RIVERSIDE AVE, RIALTO, CA 92376-6523
(909) 877-8868
(909) 877-0008
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA13946
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
GR0083640/GR0083641
MEDICAL GROUP
CA
01
—
PA13946
DHS MEDICAL
CA
01
—
ZZZ19972Z /ZZZ20075Z
MEDICARE GROUP
CA
Enumeration date
12/13/2006
Last updated
08/14/2015
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