Healthcare Provider Details

I. General information

NPI: 1477099331
Provider Name (Legal Business Name): JAN PHILLIP PESIGAN M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/16/2017
Last Update Date: 03/03/2026
Certification Date: 03/03/2026
Deactivation Date: 08/08/2025
Reactivation Date: 03/03/2026

III. Provider practice location address

3186 AIRWAY AVE STE A
COSTA MESA CA
92626-4650
US

IV. Provider business mailing address

3186 AIRWAY AVE STE A
COSTA MESA CA
92626-4650
US

V. Phone/Fax

Practice location:
  • Phone: 714-881-0427
  • Fax: 714-327-0673
Mailing address:
  • Phone: 714-881-0427
  • Fax: 714-327-0673

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: