Healthcare Provider Details

I. General information

NPI: 1235145590
Provider Name (Legal Business Name): MOWBRAY PHILIP HAGAN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/31/2006
Last Update Date: 12/11/2025
Certification Date: 12/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

760 WASHBURN AVE STE 4
CORONA CA
92882-3303
US

IV. Provider business mailing address

760 WASHBURN AVE STE 4
CORONA CA
92882-3303
US

V. Phone/Fax

Practice location:
  • Phone: 951-734-6110
  • Fax: 951-734-9989
Mailing address:
  • Phone: 951-734-6110
  • Fax: 951-734-9989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA29431
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: