Individual
CHARMAINE YOLANDA COLLINS-CEPEDA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1151 E WALNUT ST, ONTARIO, CA 91761-6155
(909) 620-7769
(877) 778-8097
Mailing address
625 FAIR OAKS AVE STE 270, SOUTH PASADENA, CA 91030-5801
(626) 346-2455
(626) 639-3005
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
03735
TX
363A00000X
Physician Assistant
Primary
PA13542
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
10/1/2012 - SAN BERN
—
CA
05
—
EFF: 02/20/13-MORENO
—
CA
05
—
EFF: 1/18/13-ONTARIO
—
CA
05
—
EFF: 1/18/13-POMONA
—
CA
05
—
EFF:2/20/13-ADELANTO
—
CA
05
—
EFF:2/20/13-NORIVERS
—
CA
01
—
P01272679/DU4034
RAILROAD MEDICARE
CA
01
—
PA13542 EFF: 6/4/12
MEDI-CAL
CA
Enumeration date
05/27/2008
Last updated
03/30/2018
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