Healthcare Provider Details

I. General information

NPI: 1881503548
Provider Name (Legal Business Name): JESSICA ERYN BALEGAL PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2026
Last Update Date: 09/07/2026
Certification Date: 09/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2800 RIVERSIDE AVE STE 101
PASO ROBLES CA
93446-1312
US

IV. Provider business mailing address

2050 S BLOSSER RD
SANTA MARIA CA
93458-7310
US

V. Phone/Fax

Practice location:
  • Phone: 805-238-7250
  • Fax:
Mailing address:
  • Phone: 805-346-3900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number68819
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: