Healthcare Provider Details

I. General information

NPI: 1730165093
Provider Name (Legal Business Name): MAHIMA JAIN P.A.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/19/2005
Last Update Date: 02/11/2025
Certification Date: 02/11/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2250 MORELLO AVE
PLEASANT HILL CA
94523-1860
US

IV. Provider business mailing address

2250 MORELLO AVE
PLEASANT HILL CA
94523-1860
US

V. Phone/Fax

Practice location:
  • Phone: 925-287-1256
  • Fax: 925-287-0913
Mailing address:
  • Phone: 925-287-1256
  • Fax: 925-287-0913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number51519
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: