Basic Information
| Provider Information | |||||||||
| NPI: | 1629591250 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | TWETEN | ||||||||
| FirstName: | PERSEPHONIE | ||||||||
| MiddleName: | ANASTASIA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6603 GRANT ST | ||||||||
| Address2: | |||||||||
| City: | CHINO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917103862 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9095619355 | ||||||||
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| Practice Location | |||||||||
| Address1: | 309 E 2ND ST | ||||||||
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| City: | POMONA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 917661854 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9096236116 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 07/25/2017 | ||||||||
| LastUpdateDate: | 07/25/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.