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General NPI Number Information
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NPI Number | 1275591356
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Entity Type | Individual
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Provider Name | CHARLES FRANCIS WETTER PA-C
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Gender | Male
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Dates
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Enumeration Date | 05/01/2006
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Last Update Date | 03/31/2023
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Provider Practice Location Address
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Address Line | 11180 WARNER AVE STE 353
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City | FOUNTAIN VALLEY
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State | CA
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Zip | 92708-7516
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Country | US
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Telephone | 714-968-6789
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Fax | 714-202-2626
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Provider Business Mailing Address
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Address Line | 31581 CANYON ESTATES DR SOUTHERN CALIFORNIA PRIMARY CARE MEDICAL GROUP
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City | LAKE ELSINORE
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State | CA
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Zip | 92532-0424
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Country | US
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Telephone | 951-244-3500
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Fax | 951-244-3535
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA13867
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License Number State | CA
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