Active NPI
Alyssa Marie Van Bibber, PAC
- Physician Assistant
- Pomona, CA
National Provider Identifier
1376887018
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA22523
- Practice address
- 1880 N Orange Grove Ave
Pomona, CA 91767-3006 - Phone
- (909) 620-7200
- Fax
- (909) 620-5800
- NPI assigned
- Nov 19, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA22523 | CA | Primary |
Addresses
Primary practice location
1880 N Orange Grove Ave
Pomona, CA 91767-3006
Mailing address
840 Towne Center Dr
Pomona, CA 91767-5900
Phone (909) 398-1550
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353283200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1458864000000",
"number": "1376887018",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "840 TOWNE CENTER DR",
"city": "POMONA",
"state": "CA",
"postal_code": "917675900",
"telephone_number": "909-398-1550",
"fax_number": "909-398-1573"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1880 N ORANGE GROVE AVE",
"city": "POMONA",
"state": "CA",
"postal_code": "917673006",
"telephone_number": "909-620-7200",
"fax_number": "909-620-5800"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VAN BIBBER",
"first_name": "ALYSSA",
"middle_name": "MARIE",
"credential": "PAC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-11-19",
"last_updated": "2016-03-25",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA22523",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pomona, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 25, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.