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General NPI Number Information
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NPI Number | 1831635168
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Entity Type | Individual
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Provider Name | DONALD GORDON EWENS III PA-C
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Gender | Male
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Dates
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Enumeration Date | 01/10/2017
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Last Update Date | 12/03/2021
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Provider Practice Location Address
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Address Line | 26520 CACTUS AVE
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City | MORENO VALLEY
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State | CA
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Zip | 92555-3927
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Country | US
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Telephone | 951-486-4000
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Fax |
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Provider Business Mailing Address
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Address Line | 7331 SHELBY PL APT 141
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City | RANCHO CUCAMONGA
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State | CA
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Zip | 91739-5914
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Country | US
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Telephone | 909-522-7219
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 54142
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License Number State | CA
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