Provider Demographics
NPI:1316168578
Name:WUEST, ROXANN ESTHER
Entity type:Individual
Prefix:MRS
First Name:ROXANN
Middle Name:ESTHER
Last Name:WUEST
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:ROXANN
Other - Middle Name:ESTHER
Other - Last Name:ROBLES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA C
Mailing Address - Street 1:716 E MISSION BLVD
Mailing Address - Street 2:
Mailing Address - City:POMONA
Mailing Address - State:CA
Mailing Address - Zip Code:91766-7203
Mailing Address - Country:US
Mailing Address - Phone:909-865-2332
Mailing Address - Fax:
Practice Address - Street 1:716 E MISSION BLVD
Practice Address - Street 2:
Practice Address - City:POMONA
Practice Address - State:CA
Practice Address - Zip Code:91766-7203
Practice Address - Country:US
Practice Address - Phone:909-865-2332
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2020-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA15646363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant