Healthcare Provider Details

I. General information

NPI: 1366841249
Provider Name (Legal Business Name): JASON MICHAEL BEBO PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/18/2014
Last Update Date: 03/24/2025
Certification Date: 03/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

NELSON ST. 41 AREA BLDG. 414006
OCEANSIDE CA
92058
US

IV. Provider business mailing address

NELSON ROAD BLDG. 414006,
OCEANSIDE CA
92058
US

V. Phone/Fax

Practice location:
  • Phone: 760-725-2873
  • Fax: 760-725-6668
Mailing address:
  • Phone: 760-725-2873
  • Fax: 760-725-6668

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1710I1002X
TaxonomyIndependent Duty Corpsman
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171000000X
TaxonomyMilitary Health Care Provider
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number1406807-1206
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: