Provider Demographics
NPI:1306074802
Name:SAWAYA, EMMANUEL (PA-C)
Entity type:Individual
Prefix:MR
First Name:EMMANUEL
Middle Name:
Last Name:SAWAYA
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:403 W F ST
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-3207
Mailing Address - Country:US
Mailing Address - Phone:909-988-3288
Mailing Address - Fax:909-988-6767
Practice Address - Street 1:403 W F ST
Practice Address - Street 2:
Practice Address - City:ONTARIO
Practice Address - State:CA
Practice Address - Zip Code:91762-3207
Practice Address - Country:US
Practice Address - Phone:909-988-3288
Practice Address - Fax:909-988-6767
Is Sole Proprietor?:No
Enumeration Date:2009-06-24
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA20007363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA20007OtherMEDICAL LICENSE
CAPA20007OtherMEDICAL LICENSE