Provider Demographics
NPI:1871712034
Name:SANMIGUEL, EPHRAIM LITONJUA JR (PAC)
Entity type:Individual
Prefix:MR
First Name:EPHRAIM
Middle Name:LITONJUA
Last Name:SANMIGUEL
Suffix:JR
Gender:M
Credentials:PAC
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Mailing Address - Street 1:2295 S VINEYARD AVE
Mailing Address - Street 2:BLDG A PRIMARY CARE 2ND FLOOR
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91761-7925
Mailing Address - Country:US
Mailing Address - Phone:888-750-0036
Mailing Address - Fax:909-264-2266
Practice Address - Street 1:2295 S VINEYARD AVE
Practice Address - Street 2:BLDG A PRIMARY CARE 2ND FLOOR
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91761-7925
Practice Address - Country:US
Practice Address - Phone:888-750-0036
Practice Address - Fax:909-264-2266
Is Sole Proprietor?:No
Enumeration Date:2007-04-25
Last Update Date:2021-11-30
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Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA13252363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13252OtherMED LIC NUMBER
CAP62011Medicare UPIN