Healthcare Provider Details

I. General information

NPI: 1417223165
Provider Name (Legal Business Name): JEANNA CASH TAPIA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JEANNA LYNN CASH

II. Dates (important events)

Enumeration Date: 03/27/2012
Last Update Date: 05/13/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2452 FENTON ST SUITE C101
CHULA VISTA CA
91914-3599
US

IV. Provider business mailing address

PO BOX 80397
SAN DIEGO CA
92138-0397
US

V. Phone/Fax

Practice location:
  • Phone: 619-600-5309
  • Fax: 619-655-4700
Mailing address:
  • Phone: 877-693-2787
  • Fax: 480-821-3610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number5015
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number22882
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: