Healthcare Provider Details

I. General information

NPI: 1033480942
Provider Name (Legal Business Name): JESSICA CUMMINGS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/24/2012
Last Update Date: 05/01/2022
Certification Date: 05/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27800 MEDICAL CENTER RD STE 260
MISSION VIEJO CA
92691-6447
US

IV. Provider business mailing address

27800 MEDICAL CENTER RD STE 260
MISSION VIEJO CA
92691-6447
US

V. Phone/Fax

Practice location:
  • Phone: 949-364-1400
  • Fax:
Mailing address:
  • Phone: 949-364-1400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA22430
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: