Healthcare Provider Details

I. General information

NPI: 1407690936
Provider Name (Legal Business Name): JANELL-FRANCINE PAGUIO NOVILLA PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/20/2024
Last Update Date: 10/20/2024
Certification Date: 10/20/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5555 GROSSMONT CENTER DR
LA MESA CA
91942-3019
US

IV. Provider business mailing address

1019 MERCED RIVER RD
CHULA VISTA CA
91913-2845
US

V. Phone/Fax

Practice location:
  • Phone: 619-740-6000
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA65223
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: