Provider Demographics
NPI:1487834644
Name:ROWAN, RYAN DANIEL (PA-C)
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DANIEL
Last Name:ROWAN
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27555 YNEZ RD STE 102
Mailing Address - Street 2:
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-4677
Mailing Address - Country:US
Mailing Address - Phone:951-302-2526
Mailing Address - Fax:833-937-2808
Practice Address - Street 1:27555 YNEZ RD STE 102
Practice Address - Street 2:
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-4677
Practice Address - Country:US
Practice Address - Phone:951-302-2526
Practice Address - Fax:833-937-2808
Is Sole Proprietor?:No
Enumeration Date:2007-11-05
Last Update Date:2023-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT67569041206363A00000X
IDPA-854363A00000X
CAPA20137363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1487834644Medicaid
ID1667771OtherMEDICARE PTAN
ID1487834644Medicaid