Basic Information
| Provider Information | |||||||||
| NPI: | 1669585840 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ERFAN | ||||||||
| FirstName: | JESSICA | ||||||||
| MiddleName: | POONEH | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MPAS, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1600 W 38TH ST STE 200 | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787316405 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123243540 | ||||||||
| FaxNumber: | 5123243541 | ||||||||
| Practice Location | |||||||||
| Address1: | 1600 W 38TH ST | ||||||||
| Address2: | SUITE 308 | ||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787315711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5123243540 | ||||||||
| FaxNumber: | 5123243541 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2006 | ||||||||
| LastUpdateDate: | 05/18/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 05/18/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363AM0700X | PA04901 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | Medical |
No ID Information.