Provider Demographics
NPI:1538989462
Name:NEVAREZ, RICK ANTHONY (MSPA, PA-C)
Entity type:Individual
Prefix:
First Name:RICK
Middle Name:ANTHONY
Last Name:NEVAREZ
Suffix:
Gender:M
Credentials:MSPA, PA-C
Other - Prefix:
Other - First Name:RICKY
Other - Middle Name:ANTHONY
Other - Last Name:NEVAREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13115 BAY MEADOW AVE
Mailing Address - Street 2:
Mailing Address - City:CHINO
Mailing Address - State:CA
Mailing Address - Zip Code:91710-5957
Mailing Address - Country:US
Mailing Address - Phone:626-665-9425
Mailing Address - Fax:
Practice Address - Street 1:13115 BAY MEADOW AVE
Practice Address - Street 2:
Practice Address - City:CHINO
Practice Address - State:CA
Practice Address - Zip Code:91710-5957
Practice Address - Country:US
Practice Address - Phone:626-665-9425
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-15
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant