Healthcare Provider Details

I. General information

NPI: 1285035808
Provider Name (Legal Business Name): CHRISTIAN MEWES PA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/15/2014
Last Update Date: 09/16/2022
Certification Date: 04/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

913 SONIA PL
ESCONDIDO CA
92026-3306
US

IV. Provider business mailing address

913 SONIA PL
ESCONDIDO CA
92026-3306
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-4866
  • Fax:
Mailing address:
  • Phone: 224-619-5023
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number085008517
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: