Healthcare Provider Details

I. General information

NPI: 1023503901
Provider Name (Legal Business Name): DONALD S. MOWLDS, M.D., A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2018
Last Update Date: 06/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 AVOCADO AVE STE 203
NEWPORT BEACH CA
92660-7703
US

IV. Provider business mailing address

1441 AVOCADO AVE STE 203
NEWPORT BEACH CA
92660-7703
US

V. Phone/Fax

Practice location:
  • Phone: 949-721-0494
  • Fax:
Mailing address:
  • Phone: 949-721-0494
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License NumberA129690
License Number StateCA

VIII. Authorized Official

Name: DR. DONALD STEWART MOWLDS JR.
Title or Position: PHYSICIAN
Credential: MD
Phone: 401-225-4319