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General NPI Number Information
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NPI Number | 1124138169
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Entity Type | Individual
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Provider Name | JODI LAINE TARUTIS PA-C
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Gender | Female
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 11/29/2021
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Provider Practice Location Address
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Address Line | 150 VALPREDA RD
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City | SAN MARCOS
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State | CA
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Zip | 92069-2973
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Country | US
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Telephone | 760-736-6700
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Fax | 760-736-6700
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Provider Business Mailing Address
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Address Line | 29573 GREENBELT CIR
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City | MENIFEE
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State | CA
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Zip | 92585-9262
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Country | US
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Telephone | 951-566-5454
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Fax | 951-566-5454
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 18111
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License Number State | CA
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