Healthcare Provider Details

I. General information

NPI: 1073947362
Provider Name (Legal Business Name): JOELLE NICOLE NEGLEY PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOELLE NICOLE BITTNER PA

II. Dates (important events)

Enumeration Date: 08/22/2013
Last Update Date: 09/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8851 CENTER DR SUITE 505
LA MESA CA
91942-3017
US

IV. Provider business mailing address

9610 GRANITE RIDGE DR SUITE B
SAN DIEGO CA
92123-2684
US

V. Phone/Fax

Practice location:
  • Phone: 619-461-3880
  • Fax: 619-461-3895
Mailing address:
  • Phone: 858-810-8000
  • Fax: 858-268-1911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number52553
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: