Provider Demographics
NPI:1144317579
Name:SYMONETT, ELMER REYMOND (MD)
Entity type:Individual
Prefix:DR
First Name:ELMER
Middle Name:REYMOND
Last Name:SYMONETT
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1035 S MOUNT VERNON AVE STE F
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-4210
Mailing Address - Country:US
Mailing Address - Phone:909-824-1060
Mailing Address - Fax:909-824-0501
Practice Address - Street 1:1035 S MOUNT VERNON AVE STE F
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-4210
Practice Address - Country:US
Practice Address - Phone:909-824-1060
Practice Address - Fax:909-824-0501
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-06
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA050238174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1336924Medicaid
CA00A502380Medicaid
CAF40350Medicare UPIN