Healthcare Provider Details

I. General information

NPI: 1245126713
Provider Name (Legal Business Name): CARL LOUIS ROWENS III
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/13/2025
Last Update Date: 09/11/2025
Certification Date: 06/12/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12829 EASTERN SHORE DR
EASTVALE CA
92880-3458
US

IV. Provider business mailing address

12829 EASTERN SHORE DR
EASTVALE CA
92880-3458
US

V. Phone/Fax

Practice location:
  • Phone: 951-818-2176
  • Fax:
Mailing address:
  • Phone: 951-818-2176
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TF0000X
TaxonomyFamily Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: