Healthcare Provider Details

I. General information

NPI: 1366226680
Provider Name (Legal Business Name): ADAM SAMUEL CEJA PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2023
Last Update Date: 10/25/2025
Certification Date: 10/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50249 CESAR CHAVEZ ST STE K
COACHELLA CA
92236-1530
US

IV. Provider business mailing address

9055 BALBOA AVE
SAN DIEGO CA
92123-1509
US

V. Phone/Fax

Practice location:
  • Phone: 760-393-0555
  • Fax: 760-393-0522
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65817
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: