Individual
PK LOGAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
150 LAGUNA RD, FULLERTON, CA 92835-3614
(714) 447-4800
(714) 447-1098
Mailing address
832 SUNSET DR, HERMOSA BEACH, CA 90254-4248
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA12280
CA
Other
Enumeration date
02/15/2007
Last updated
09/24/2018
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