MEDICARE: MRS. ALPANA BALA JAYADEVAN NP

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
1	363L00000X	Nurse Practitioner	RN213404	GA
2	363L00000X	Nurse Practitioner	95039036	CA

General Provider Information

NPI Number	:	1386277036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ALPANA BALA JAYADEVAN NP

Provider Business Mailing Address
First Line	:	3900 5TH AVE STE 110
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3122
Country	:	US
Telephone Number	:	858-554-1212
Fax Number	:

Provider Business Practice Location Address
First Line	:	3900 5TH AVE STE 110
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92103-3122
Country	:	US
Telephone Number	:	858-554-1212
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/20/2020
Last Update Date	:	04/21/2026

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