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General NPI Number Information
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NPI Number | 1992307235
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Entity Type | Individual
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Provider Name | JESSICA RAE WITZMANN PA
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Gender | Female
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Dates
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Enumeration Date | 11/11/2020
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Last Update Date | 06/25/2025
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Provider Practice Location Address
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Address Line | 25500 RANCHO NIGUEL RD STE 100
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City | LAGUNA NIGUEL
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State | CA
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Zip | 92677-7373
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Country | US
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Telephone | 949-643-0500
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Fax |
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Provider Business Mailing Address
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Address Line | 421 N HIGHWAY 101
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City | SOLANA BEACH
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State | CA
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Zip | 92075-1131
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Country | US
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Telephone | 858-330-3737
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Fax | 858-346-0376
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA59067
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License Number State | CA
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