Provider Demographics
NPI:1619229283
Name:SHRADER, MICHAEL BRIAN (PA-C)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:BRIAN
Last Name:SHRADER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:28078 BAXTER RD STE 530
Mailing Address - Street 2:
Mailing Address - City:MURRIETA
Mailing Address - State:CA
Mailing Address - Zip Code:92563-1405
Mailing Address - Country:US
Mailing Address - Phone:951-566-5229
Mailing Address - Fax:
Practice Address - Street 1:28078 BAXTER RD STE 530
Practice Address - Street 2:
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92563-1405
Practice Address - Country:US
Practice Address - Phone:951-566-5229
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-10-08
Last Update Date:2025-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CA58579363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant