Provider Demographics
NPI:1275591356
Name:WETTER, CHARLES FRANCIS (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHARLES
Middle Name:FRANCIS
Last Name:WETTER
Suffix:
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:31581 CANYON ESTATES DR
Mailing Address - Street 2:SOUTHERN CALIFORNIA PRIMARY CARE MEDICAL GROUP
Mailing Address - City:LAKE ELSINORE
Mailing Address - State:CA
Mailing Address - Zip Code:92532-0424
Mailing Address - Country:US
Mailing Address - Phone:951-244-3500
Mailing Address - Fax:951-244-3535
Practice Address - Street 1:11180 WARNER AVE STE 353
Practice Address - Street 2:
Practice Address - City:FOUNTAIN VALLEY
Practice Address - State:CA
Practice Address - Zip Code:92708-7516
Practice Address - Country:US
Practice Address - Phone:714-968-6789
Practice Address - Fax:714-202-2626
Is Sole Proprietor?:No
Enumeration Date:2006-05-01
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA13867363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPA13687OtherCA STATE LIC
MW0558366OtherDEA