Provider Demographics
NPI:1003911892
Name:FERNS, JAY A (DO)
Entity Type:Individual
Prefix:DR
First Name:JAY
Middle Name:A
Last Name:FERNS
Suffix:
Gender:M
Credentials:DO
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Mailing Address - Street 1:29738 RANCHO CALIFORNIA RD
Mailing Address - Street 2:SUITE B
Mailing Address - City:TEMECULA
Mailing Address - State:CA
Mailing Address - Zip Code:92591-5286
Mailing Address - Country:US
Mailing Address - Phone:951-308-1822
Mailing Address - Fax:951-699-6734
Practice Address - Street 1:29738 RANCHO CALIFORNIA RD
Practice Address - Street 2:SUITE B
Practice Address - City:TEMECULA
Practice Address - State:CA
Practice Address - Zip Code:92591-5286
Practice Address - Country:US
Practice Address - Phone:951-308-1822
Practice Address - Fax:951-699-6734
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-14
Last Update Date:2021-11-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CA20A6131207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA330898975OtherTAX I.D. #
CA020A61310Medicare ID - Type Unspecified