Healthcare Provider Details

I. General information

NPI: 1861725392
Provider Name (Legal Business Name): JESSICA BROWER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/16/2009
Last Update Date: 09/16/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 SANTA FE DR STE 108
ENCINITAS CA
92024-5138
US

IV. Provider business mailing address

3907 WARING RD STE 2
OCEANSIDE CA
92056-4454
US

V. Phone/Fax

Practice location:
  • Phone: 760-942-1390
  • Fax: 760-942-4288
Mailing address:
  • Phone: 760-631-3000
  • Fax: 760-631-3016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA20510
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: