Provider Demographics
NPI:1386402071
Name:RADOI, NAOMI ELIZABETH (PA-C)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:ELIZABETH
Last Name:RADOI
Suffix:
Gender:F
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 1:11154 SPRUCE AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:CA
Mailing Address - Zip Code:92316-3226
Mailing Address - Country:US
Mailing Address - Phone:909-561-7987
Mailing Address - Fax:
Practice Address - Street 1:6926 BROCKTON AVE STE 11
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92506-3804
Practice Address - Country:US
Practice Address - Phone:951-779-1670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-08
Last Update Date:2024-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA63439363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical