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General NPI Number Information
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NPI Number | 1245056688
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Entity Type | Individual
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Provider Name | JASON COWEN PA
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Gender | Male
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Dates
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Enumeration Date | 12/02/2024
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Last Update Date | 02/11/2025
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Provider Practice Location Address
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Address Line | 8805 HAVEN AVE STE 100
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91730-5149
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Country | US
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Telephone | 909-912-1750
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Fax |
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Provider Business Mailing Address
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Address Line | 33562 YUCAIPA BLVD STE. 4 #1112
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City | YUCAIPA
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State | CA
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Zip | 92399
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Country | US
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Telephone | 909-353-3570
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 65813
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License Number State | CA
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