Provider Demographics
NPI:1528756459
Name:LOCKMAN, ABIGAIL ROSE
Entity type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:ROSE
Last Name:LOCKMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:ABBY
Other - Middle Name:
Other - Last Name:LOCKMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:522 WRIGHTWOOD RD
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92879-8542
Mailing Address - Country:US
Mailing Address - Phone:951-520-7809
Mailing Address - Fax:
Practice Address - Street 1:25455 BARTON RD STE 102B
Practice Address - Street 2:
Practice Address - City:LOMA LINDA
Practice Address - State:CA
Practice Address - Zip Code:92354-3139
Practice Address - Country:US
Practice Address - Phone:909-558-2808
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-27
Last Update Date:2024-01-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63267363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant