HENDERSON SURGICAL PHYSICIAN ASSISTANT (NPI# 1982129342) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1982129342 |
| Entity Type | Organization |
| Organization Name | HENDERSON SURGICAL PHYSICIAN ASSISTANT |
| Practice Address |
4445 Magnolia Ave Riverside CA 92501-4135 |
| Mailing Address |
12625 Frederick St # I5215 Moreno Valley CA 92553-5216 |
| Practice Telephone | 9514439606 |
| Mailing Telephone | 9514439606 |
| Enumeration Date | 2017-08-07 |
| Last Update Date | 2017-08-07 |
| Authorized Official Name | SOFIA HENDERSON (PRESIDENT) |
| Authorized Official Telephone | 9514439606 |
| Authorized Official Credential | PHYSCIAN ASSISTA |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363AS0400X |
Physician Assistant Specialization: Surgical Technologist |
51407 | CA | Physician Assistants & Advanced Practice Nursing Providers |
| Street Address |
4445 MAGNOLIA AVE |
| City | RIVERSIDE |
| State | CA |
| Zip Code | 92501-4135 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1801897731 | Donald R Massee | Radiology | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2005-08-02 |
| 1215538392 | Nicole Barnard | Nurse Practitioner | 4445 Magnolia Ave, Riverside, CA 92501-4199 | 2020-11-04 |
| 1942808811 | Nelson Javier Maravilla | Nurse Anesthetist, Certified Registered | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2020-10-13 |
| 1801494026 | Clinton William Hart | Nurse Practitioner | 4445 Magnolia Ave, Riverside, CA 92501-4199 | 2020-10-09 |
| 1578179677 | Dallas Mckinley Bessette | Nurse Anesthetist, Certified Registered | 4445 Magnolia Ave, Riverside, CA 92501-4199 | 2020-09-23 |
| 1124641444 | Emely Rebekah Garcia | Anesthesiology | 4445 Magnolia Ave, Riverside, CA 92501-4199 | 2020-05-20 |
| 1447872429 | Seena Khosravi | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2020-05-12 |
| 1336761519 | Alexandra May Bock | Nurse Anesthetist, Certified Registered | 4445 Magnolia Ave, Riverside, CA 92501-4199 | 2020-05-11 |
| 1568084747 | Courtney Lynn Hipkin | Nurse Anesthetist, Certified Registered | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2020-05-11 |
| 1003438193 | Shalini Sunil Shah | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2020-05-11 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1700437605 | Mary Horvatin | Technician | 1811 Rivera Strret, Riverside, CA 92501 | 2019-09-23 |
| 1366905473 | Timothy Daniel Collins | Student in an Organized Health Care Education/Training Program | Riverside Community Hospital, 4445 Magnolia Ave., Gme, Office, Riverside, CA 92501 | 2019-04-08 |
| 1346709672 | Lourdes Adame | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Ave - Gme Office, Riverside, CA 92501 | 2019-03-16 |
| 1740759067 | Kristina Ferris-celosse | Counselor | 2452 Wilshire St., Riverside, CA 92501 | 2018-11-15 |
| 1750888095 | Arunmozhi Aravagiri | Student in an Organized Health Care Education/Training Program | Riverside Community Hospital, Gme Office, 4445 Magnolia Ave., Riverside, CA 92501 | 2018-04-12 |
| 1720585847 | Alan Huynh | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Avenue., Gme Office, Riverside, CA 92501 | 2018-04-06 |
| 1538664834 | Wilson Paul Frasca | Student in an Organized Health Care Education/Training Program | 4445 Magnolia Avenue, Riverside, CA 92501 | 2018-03-28 |
| 1851896575 | Geethu Gopinathan Nair | Student in an Organized Health Care Education/Training Program | Riverside Community Hospital, 4445 Magnolia Ave., Gme Office, Riverside, CA 92501 | 2018-03-26 |
| 1316465560 | Thilini Anne Abeygunaratne | Marriage & Family Therapist | 1950 Market Street, Riverside, CA 92501 | 2017-09-07 |
| 1194257410 | Melissa Chitwood | Assistant Behavior Analyst | 3078 Cedar St., Riverside, CA 92501 | 2017-03-28 |
| Find all providers in zip 92501 | ||||
| Taxonomy Code | 363AS0400X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| Specialization | Surgical Technologist |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1023500592 | Pamela Lambert Pa-c, Inc. | Physician Assistant | 16105 Mariposa Ave, Riverside, CA 92504-8730 | 2018-05-31 |
| 1265716302 | Allen Y. Iloreta | Physician Assistant | 10600 Magnolia Ave Ste I, Riverside, CA 92505-1819 | 2011-10-07 |
| 1457300436 | Mission Surgical Clinic, Inc. | Physician Assistant | 3660 Park Sierra Dr, Suite 105, Riverside, CA 92505-3071 | 2006-05-08 |
| 1023079183 | Haider Spine Center Medical Group | Physician Assistant | 6276 River Crest Dr, Riverside, CA 92507-0754 | 2006-03-29 |
| 1851755128 | Anthony Cramer | Physician Assistant | 6276 River Crest Dr, Riverside, CA 92507-0783 | 2016-04-12 |
| 1912307448 | Jennifer Kang | Physician Assistant | 353 E Burlington St, Suite 100, Riverside, IL 60546-2189 | 2014-09-03 |
| 1750533618 | Kayleeta Evonne Robinson | Physician Assistant | 4445 Magnolia Ave, Riverside, CA 92501-4135 | 2008-10-22 |
| 1588750152 | Monica Falcon | Physician Assistant | 3660 Park Sierra Dr, Suite 105, Riverside, CA 92505-3071 | 2006-10-04 |
| 1417058934 | Alan D Moses | Physician Assistant | 353 E Burlington St, Suite 100, Riverside, IL 60546-2189 | 2006-09-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1649894403 | Kathlyn Larco | Physician Assistant | 1233 W Randall Way, West Covina, CA 91790-4747 | 2020-06-07 |
| 1487126421 | Eliza Hughes | Physician Assistant | 860 Oak Park Blvd Ste 101, Arroyo Grande, CA 93420-1800 | 2018-12-31 |
| 1508333873 | Andrew Cantos Malit | Physician Assistant | 409 Bristol Way, Corona, CA 92879-6156 | 2018-10-25 |
| 1578049458 | Ida Jelveh | Physician Assistant | 28096 Edelweiss Ct, Laguna Niguel, CA 92677-7006 | 2018-07-13 |
| 1356833578 | Michael James Gonzalez | Physician Assistant | 1500 E Chevy Chase Dr # 401a401b, Glendale, CA 91206-4152 | 2018-06-04 |
| 1225532385 | Folsom Physicain Assistant First Assist, Inc | Physician Assistant | Nina Vasiliev Pa-c, 15407 Muller Rd, Plymouth, CA 95669-9770 | 2018-03-22 |
| 1275040008 | Gm Surgical Assistant Inc | Physician Assistant | 15615 Turnberry St, Moreno Valley, CA 92555-4901 | 2018-01-02 |
| 1902311186 | Or Solutions Inc | Physician Assistant | 1501 Secret Ravine Pkwy Unit 527, Roseville, CA 95661-6005 | 2017-12-09 |
| 1184143828 | Alaa Abdalla Daghlas | Physician Assistant | 1100 S Eliseo Dr Ste A, Greenbrae, CA 94904-2017 | 2017-09-13 |
| 1891227823 | Julieta A. Murillo | Physician Assistant | 1 Quality Dr Ste B36, Vacaville, CA 95688-9494 | 2017-03-29 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.