MEDICARE: JARON WESLEY TAYLOR PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	171000000X	Military Health Care Provider		CA
2	363A00000X	Physician Assistant

General Provider Information

NPI Number	:	1356980684
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JARON WESLEY TAYLOR PA

Provider Business Mailing Address
First Line	:	200 TRIDENT WAY
Second Line	:
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-0001
Country	:	US
Telephone Number	:	360-878-1644
Fax Number	:

Provider Business Practice Location Address
First Line	:	NAVAL SPECIAL WARFARE COMMAND
Second Line	:	200 TRIDENT WAY
City	:	SAN DIEGO
State	:	CA
Zip	:	92155-0001
Country	:	US
Telephone Number	:	360-878-1644
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/03/2020
Last Update Date	:	01/21/2026

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