Active NPI
Paul J Dewaard, P.A.
- Physician Assistant
- Riverside, CA
National Provider Identifier
1326051533
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- PA11241
- Practice address
- 7140 Indiana Ave
Riverside, CA 92504-4544 - Phone
- (951) 358-6000
- Fax
- (951) 358-6044
- NPI assigned
- Aug 15, 2006
- Last updated
- Mar 7, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | PA11241 | CA | Primary |
Addresses
Primary practice location
7140 Indiana Ave
Riverside, CA 92504-4544
Mailing address
PO Box 7849
Riverside, CA 92513-7849
Phone (951) 358-5222
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 11241 | CA | MD | Optometrist |
| PA11241 | CA | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1155600000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1678147200000",
"number": "1326051533",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 7849",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925137849",
"telephone_number": "951-358-5222",
"fax_number": "951-358-5235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7140 INDIANA AVE",
"city": "RIVERSIDE",
"state": "CA",
"postal_code": "925044544",
"telephone_number": "951-358-6000",
"fax_number": "951-358-6044"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEWAARD",
"first_name": "PAUL",
"middle_name": "J",
"name_prefix": "Mr.",
"credential": "P.A.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-15",
"last_updated": "2023-03-07",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "CA",
"license": "PA11241",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Riverside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.