Healthcare Provider Details

I. General information

NPI: 1912213349
Provider Name (Legal Business Name): KARI JO VANOCKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/23/2010
Last Update Date: 02/07/2023
Certification Date: 02/07/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3750 CONVOY ST STE 201
SAN DIEGO CA
92111-3770
US

IV. Provider business mailing address

4445 EASTGATE MALL STE 105
SAN DIEGO CA
92121-1979
US

V. Phone/Fax

Practice location:
  • Phone: 858-278-8300
  • Fax:
Mailing address:
  • Phone: 858-412-6080
  • Fax: 858-412-6376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21109
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA21109
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: