Healthcare Provider Details

I. General information

NPI: 1467707406
Provider Name (Legal Business Name): SHAWN PHILIP PLOWMAN PA-C MMS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2012
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 CORPORATE DR STE 100
LADERA RANCH CA
92694-1153
US

IV. Provider business mailing address

PO BOX 35380
LAS VEGAS NV
89133-5380
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-9112
  • Fax: 949-364-9016
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number22377
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: