Provider Demographics
NPI:1982849600
Name:KOWALLIS, DAVID WRIGHT (PA)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:WRIGHT
Last Name:KOWALLIS
Suffix:
Gender:M
Credentials:PA
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Mailing Address - Street 1:393 E WALNUT ST PHR GROUP UNIT 3RD FL
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91188-0001
Mailing Address - Country:US
Mailing Address - Phone:877-608-0044
Mailing Address - Fax:877-514-0903
Practice Address - Street 1:41715 WINCHESTER RD
Practice Address - Street 2:SUITE 101
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92590-4808
Practice Address - Country:US
Practice Address - Phone:951-308-4451
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-12-09
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA20053363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical