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NPI Code Detail

MEDICARE: JEREMY ELKINS PA-C

MEDICARE: JEREMY ELKINS PA-C
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363AM0700XMedical Physician AssistantPA18144CA

General Provider Information

NPI Number : 1003961749
Entity Type Code : Individual
Provider Name (Legal Business Name) : JEREMY ELKINS PA-C
Provider Business Mailing Address
First Line : 1550 SUPERIOR AVE
Second Line :
City : COSTA MESA
State : CA
Zip : 92627-3653
Country : US
Telephone Number : 949-650-0186
Fax Number : 949-650-6976
Provider Business Practice Location Address
First Line : 1550 SUPERIOR AVE
Second Line :
City : COSTA MESA
State : CA
Zip : 92627-3653
Country : US
Telephone Number : 949-650-0186
Fax Number : 949-650-6976
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/24/2007
Last Update Date : 07/08/2007

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Directions to “ JEREMY ELKINS PA-C” Practice Location

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