Provider Demographics
NPI:1962514661
Name:EARLEY, BILLY Z (PA)
Entity type:Individual
Prefix:
First Name:BILLY
Middle Name:Z
Last Name:EARLEY
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1307 W 6TH ST STE 102&103
Mailing Address - Street 2:
Mailing Address - City:CORONA
Mailing Address - State:CA
Mailing Address - Zip Code:92882-3294
Mailing Address - Country:US
Mailing Address - Phone:951-520-1003
Mailing Address - Fax:951-520-1872
Practice Address - Street 1:1307 W 6TH ST STE 102&103
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92882-3294
Practice Address - Country:US
Practice Address - Phone:951-520-1003
Practice Address - Fax:951-520-1872
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA15350363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0PA15350Medicare UPIN