Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Mr. Wade Garret Fueconcillo

Individual provider Orthopaedic Surgery Physician · NPI 1912496423

Mr. Wade Garret Fueconcillo is a Physician Assistant in Colton, California. Qualified in 2018, 8 years ago. Practices with Southern California Permanente Medical Group, an 11,242-clinician group and accepts Medicare assignment. Licensed in California.

Years since qualifying
8
Licensed in
CA
In the registry since
2018
Specialties on file
2

Practice location Address checks out

400 N Pepper Ave
Colton, CA 92324-1801
Phone: (909) 580-1775
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X
Orthopaedic Surgery Physician Taxonomy 207X00000X · Licence PA55900 (CA)

Record details

NPI number1912496423
Entity typeIndividual (Type 1)
GenderMale
Sole proprietorNo
NPI enumeratedMay 10, 2018
Last updated in NPPESDecember 6, 2021
Certification dateAugust 4, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyPHYSICIAN ASSISTANT
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Southern California Permanente Medical Group — 11242 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations6 on file with Medicare

Other providers in Colton