Healthcare Provider Details

I. General information

NPI: 1255896551
Provider Name (Legal Business Name): DAVID ANDREW WARD PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2019
Last Update Date: 05/27/2026
Certification Date: 05/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

729 SUNRISE AVE STE 602
ROSEVILLE CA
95661-4542
US

IV. Provider business mailing address

729 SUNRISE AVE STE 602
ROSEVILLE CA
95661-4542
US

V. Phone/Fax

Practice location:
  • Phone: 916-953-7571
  • Fax: 916-771-8515
Mailing address:
  • Phone: 916-953-7571
  • Fax: 916-771-8515

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.0009123
License Number StateCO
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA2087
License Number StateNV
# 3
Primary TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License NumberPA61427
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: