Provider Demographics
NPI:1912984535
Name:EHLERS, JUSTUS KENNETH JR (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JUSTUS
Middle Name:KENNETH
Last Name:EHLERS
Suffix:JR
Gender:M
Credentials:PA-C
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Mailing Address - Street 1:43500 RIDGE PARK DR
Mailing Address - Street 2:SUITE: 102
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92590-3624
Mailing Address - Country:US
Mailing Address - Phone:951-699-0303
Mailing Address - Fax:951-699-0603
Practice Address - Street 1:25495 MEDICAL CENTER DR
Practice Address - Street 2:SUITE: 102
Practice Address - City:MURRIETA
Practice Address - State:CA
Practice Address - Zip Code:92562-5963
Practice Address - Country:US
Practice Address - Phone:951-506-9536
Practice Address - Fax:951-693-4631
Is Sole Proprietor?:No
Enumeration Date:2005-12-23
Last Update Date:2023-03-07
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Provider Licenses
StateLicense IDTaxonomies
CA19655363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAME1874874OtherDEA