Healthcare Provider Details

I. General information

NPI: 1356353361
Provider Name (Legal Business Name): MOWBRAY P. HAGAN, M.D. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2006
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 Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License NumberA29431
License Number StateCA

VIII. Authorized Official

Name: DR. MOWBRAY P. HAGAN
Title or Position: PRESIDENT
Credential: M.D.
Phone: 951-734-6110