Miss Mallory Katherine Willenborg, PA-C is a medicare enrolled "Emergency Medicine" in Colton, California. Her current practice location is
400 N Pepper Ave, Colton, California. You can reach out to her office (for appointments etc.) via phone at
(909) 580-1000.
Miss Mallory Katherine Willenborg is licensed to practice in California (license number 53867) and she also participates in the medicare program. She does not accept medicare assignments directly but she may accept medicare through third-party (refer to Reassignment section below) and may also prescribe medicare part D drugs. Her NPI Number is 1598213886.
Provider's Profile
Full Name | Miss Mallory Katherine Willenborg |
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Gender | Female |
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Speciality | Emergency Medicine |
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Location | 400 N Pepper Ave, Colton, California |
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Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
NPI Data:
- NPI Number: 1598213886
- Provider Enumeration Date: 09/14/2016
- Last Update Date: 12/10/2016
Medicare PECOS Information:
- PECOS PAC ID: 0446530216
- Enrollment ID: I20161213002443
Medical Identifiers
Medical identifiers for Miss Mallory Katherine Willenborg such as npi, medicare ID, medicare PIN, medicaid, etc.
Identifier | Type | State | Issuer |
1598213886 | NPI | - | NPPES |
Medical Taxonomies and Licenses
Taxonomy | Type | License (State) | Status |
363A00000X | Physician Assistant | 9109799 (Florida) | Secondary |
207P00000X | Emergency Medicine | 53867 (California) | Primary |
Medicare Part D Prescriber Enrollment
Any physician or other eligible professional who prescribes Part D drugs must either enroll in the Medicare program or opt out in order to prescribe drugs to their patients with Part D prescription drug benefit plans. Miss Mallory Katherine Willenborg is
enrolled with medicare and thus, if eligible, can prescribe medicare part D drugs to patients with medicare part D benefits.
Mailing Address and Practice Location
Mailing Address | Practice Location Address |
Miss Mallory Katherine Willenborg, PA-C 1255 Ne 95th St, Miami Shores, FL 33138-2549 Ph: (305) 450-6031 | Miss Mallory Katherine Willenborg, PA-C 400 N Pepper Ave, Colton, CA 92324-1801 Ph: (909) 580-1000 |
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