Healthcare Provider Details

I. General information

NPI: 1942627880
Provider Name (Legal Business Name): JENNIFER SEBASTIAN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/27/2014
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3151 AIRWAY AVE STE G1
COSTA MESA CA
92626-4624
US

IV. Provider business mailing address

3151 AIRWAY AVE STE G1
COSTA MESA CA
92626-4624
US

V. Phone/Fax

Practice location:
  • Phone: 714-545-5550
  • Fax: 714-708-2588
Mailing address:
  • Phone: 714-545-5550
  • Fax: 714-708-2588

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number51365
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: