Basic Information
| Provider Information | |||||||||
| NPI: | 1417223165 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TAPIA | ||||||||
| FirstName: | JEANNA | ||||||||
| MiddleName: | CASH | ||||||||
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| Credential: | PA-C | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | CASH | ||||||||
| OtherFirstName: | JEANNA | ||||||||
| OtherMiddleName: | LYNN | ||||||||
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| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | PO BOX 80397 | ||||||||
| Address2: | |||||||||
| City: | SAN DIEGO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 921380397 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8776932787 | ||||||||
| FaxNumber: | 4808213610 | ||||||||
| Practice Location | |||||||||
| Address1: | 2452 FENTON ST | ||||||||
| Address2: | SUITE C101 | ||||||||
| City: | CHULA VISTA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 919143599 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6196005309 | ||||||||
| FaxNumber: | 6196554700 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2012 | ||||||||
| LastUpdateDate: | 05/13/2013 | ||||||||
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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 | 363AM0700X | 5015 | AZ | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical | 363AM0700X | 22882 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.