=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922269521
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JORY JAMES ADAM PA-C
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/17/2008
-----------------------------------------------------
Last Update Date | 11/22/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 22431 ANTONIO PKWY # B160-613
-----------------------------------------------------
City | RANCHO SANTA MARGARITA
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92688-2804
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 855-727-2251
-----------------------------------------------------
Fax | 855-727-2251
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5085 CAMINITO EXQUISITO
-----------------------------------------------------
City | SAN DIEGO
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92130-2851
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 858-209-9285
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | 10725
-----------------------------------------------------
License Number State | AZ
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363AS0400X
-----------------------------------------------------
Taxonomy Name | Surgical Physician Assistant
-----------------------------------------------------
License Number | 0110002794
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------