Provider Demographics
NPI:1033540554
Name:UNRUH, JASON (PA-C)
Entity Type:Individual
Prefix:MR
First Name:JASON
Middle Name:
Last Name:UNRUH
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2710 ADAMS AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92116-1312
Mailing Address - Country:US
Mailing Address - Phone:619-663-6349
Mailing Address - Fax:619-684-3790
Practice Address - Street 1:2710 ADAMS AVE
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92116-1312
Practice Address - Country:US
Practice Address - Phone:619-663-6349
Practice Address - Fax:619-684-3790
Is Sole Proprietor?:No
Enumeration Date:2013-12-09
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21321363AM0700X, 363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical