Healthcare Provider Details

I. General information

NPI: 1619048451
Provider Name (Legal Business Name): HELENE SY JOLLY PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2006
Last Update Date: 08/03/2022
Certification Date: 08/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8860 CENTER DR SUITE 300
LA MESA CA
91942-3068
US

IV. Provider business mailing address

8860 CENTER DR STE 300
LA MESA CA
91942-7001
US

V. Phone/Fax

Practice location:
  • Phone: 619-462-1670
  • Fax:
Mailing address:
  • Phone: 619-462-1670
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA16958
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: