Individual provider Active NPI

John Denton Olson, P.A.- C

  • Physician Assistant
  • Temecula, CA
National Provider Identifier
1326340225
Registry record updated Nov 28, 2010
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
21362 Issued in CA
Practice address
31675 Calle Barcaldo
Temecula, CA 92592-3611
Phone
(951) 302-0641
Fax
(951) 302-0642
NPI assigned
Nov 28, 2010
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Nov 28, 2010

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 21362 CA Primary

Addresses

Primary practice location

31675 Calle Barcaldo
Temecula, CA 92592-3611

Mailing address

31675 Calle Barcaldo
Temecula, CA 92592-3611
Phone (951) 302-0641

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20110405000957 CA Practitioner - Physician Assistant 3870777444 Reassigns benefits to 2 organizations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
21362CAMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Nogales Medical Clinic, Inc CurrentSince Dec 9, 2019 Accepting new patients
Inland Urgent Care a Medical Corporation CurrentSince Sep 1, 2018 Accepting new patients

Locations

31588 Railroad Canyon Rd
Canyon Lake, CA 92587

24805 Alessandro Blvd
Ste 8
Moreno Valley, CA 92553
Phone (951) 601-6618

36320 Inland Valley Dr
Ste 307
Wildomar, CA 92595
Phone (909) 600-0110

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1290902400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1290902400000",
    "number": "1326340225",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "31675 CALLE BARCALDO",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925923611",
            "telephone_number": "951-302-0641",
            "fax_number": "951-302-0642"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "31675 CALLE BARCALDO",
            "city": "TEMECULA",
            "state": "CA",
            "postal_code": "925923611",
            "telephone_number": "951-302-0641",
            "fax_number": "951-302-0642"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OLSON",
        "first_name": "JOHN",
        "middle_name": "DENTON",
        "credential": "P.A.- C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2010-11-28",
        "last_updated": "2010-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "CA",
            "license": "21362",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Temecula, CA

Sources for this page

Verify at the official NPI Registry.