Healthcare Provider Details

I. General information

NPI: 1033735329
Provider Name (Legal Business Name): OANA GRIGORAS PICKERING PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: OANA GRIGORAS

II. Dates (important events)

Enumeration Date: 06/22/2020
Last Update Date: 06/28/2023
Certification Date: 06/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

555 W C ST STE 102
SAN DIEGO CA
92101-8470
US

IV. Provider business mailing address

9850 GENESEE AVE STE 320
LA JOLLA CA
92037-1208
US

V. Phone/Fax

Practice location:
  • Phone: 858-554-1212
  • Fax: 858-795-1195
Mailing address:
  • Phone: 858-554-1212
  • Fax: 858-795-1195

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA58218
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: