Organization
HENDERSON SURGICAL PHYSICIAN ASSISTANT
Active
Organization subpart
No
Provider details
NPI number
Authorized official
SOFIA HENDERSON PHYSCIAN ASSISTANT (PRESIDENT)
(951) 443-9606
Entity
Organization
Contact information
Practice address
4445 MAGNOLIA AVE, RIVERSIDE, CA 92501-4135
(951) 443-9606
Mailing address
12625 FREDERICK ST # I5215, MORENO VALLEY, CA 92553-5216
(951) 443-9606
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
51407
CA
Other
Enumeration date
08/07/2017
Last updated
08/07/2017
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