Basic Information
| Provider Information | |||||||||
| NPI: | 1275598591 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | ATTIA | ||||||||
| FirstName: | JILL | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | C.R.N.P. | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 232410 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921932410 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8582496748 | ||||||||
| FaxNumber: | 6195433183 | ||||||||
| Practice Location | |||||||||
| Address1: | 3855 HEALTH SCIENCES DR | ||||||||
| Address2: | UCSD MOORES CANCER CENTER | ||||||||
| City: | LA JOLLA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920931503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4109525895 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/19/2006 | ||||||||
| LastUpdateDate: | 06/15/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | R149302 | MD | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 407889600 | 05 | MD | MEDICAID |