Healthcare Provider Details

I. General information

NPI: 1437598695
Provider Name (Legal Business Name): JESSICA LEE LIN PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JESSICA LEE

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 07/28/2020
Certification Date: 07/28/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9300 CAMPUS POINT DR MAIL CODE #7411
LA JOLLA CA
92037-1300
US

IV. Provider business mailing address

PO BOX 232410
SAN DIEGO CA
92193-2410
US

V. Phone/Fax

Practice location:
  • Phone: 858-657-8530
  • Fax: 858-657-8814
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA23003
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: