Healthcare Provider Details

I. General information

NPI: 1003791724
Provider Name (Legal Business Name): DAVID WARSOF PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/11/2025
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

744 BROADWAY STE 100
EL CAJON CA
92021-4654
US

IV. Provider business mailing address

744 BROADWAY STE 100
EL CAJON CA
92021-4654
US

V. Phone/Fax

Practice location:
  • Phone: 619-456-9292
  • Fax: 619-456-9283
Mailing address:
  • Phone: 619-456-9292
  • Fax: 619-456-9283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number68179
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: