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General NPI Number Information
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NPI Number | 1497641732
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Entity Type | Individual
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Provider Name | JOHN HATHAWAY NP
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Gender | Male
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Dates
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Enumeration Date | 06/13/2025
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 31571 CANYON ESTATES DR STE 228
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City | LAKE ELSINORE
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State | CA
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Zip | 92532-0425
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Country | US
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Telephone | 951-471-0200
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Fax |
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Provider Business Mailing Address
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Address Line | 138 BRACEBRIDGE RD
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City | RIVERSIDE
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State | CA
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Zip | 92506-6114
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Country | US
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Telephone | 951-454-7086
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 95238727
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 95035568
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License Number State | CA
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