Healthcare Provider Details

I. General information

NPI: 1033540554
Provider Name (Legal Business Name): JASON UNRUH PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2013
Last Update Date: 01/08/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3812 BERNICE DR
SAN DIEGO CA
92107-2702
US

IV. Provider business mailing address

PO BOX 99087
SAN DIEGO CA
92169-1087
US

V. Phone/Fax

Practice location:
  • Phone: 619-861-9759
  • Fax: 619-684-3790
Mailing address:
  • Phone: 619-861-9759
  • Fax: 619-684-3790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number21321
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number21321
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: