Healthcare Provider Details

I. General information

NPI: 1982849600
Provider Name (Legal Business Name): DAVID WRIGHT KOWALLIS P.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2008
Last Update Date: 12/08/2021
Certification Date: 12/23/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

41715 WINCHESTER RD SUITE 101
TEMECULA CA
92590-4808
US

IV. Provider business mailing address

393 E WALNUT ST PHR GROUP UNIT 3RD FL
PASADENA CA
91188-0001
US

V. Phone/Fax

Practice location:
  • Phone: 951-308-4451
  • Fax:
Mailing address:
  • Phone: 877-608-0044
  • Fax: 877-514-0903

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number20053
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: