Provider Demographics
NPI:1053496927
Name:GOERIG, JESSICA D (PA)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:D
Last Name:GOERIG
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:33971 SELVA ROAD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:DANA POINT
Mailing Address - State:CA
Mailing Address - Zip Code:92629
Mailing Address - Country:US
Mailing Address - Phone:949-276-2600
Mailing Address - Fax:949-276-2601
Practice Address - Street 1:33971 SELVA RD STE 200
Practice Address - Street 2:
Practice Address - City:DANA POINT
Practice Address - State:CA
Practice Address - Zip Code:92629-3782
Practice Address - Country:US
Practice Address - Phone:949-276-2600
Practice Address - Fax:949-276-2601
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2018-10-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA19810363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1538405766OtherTRICARE PPO
CA1538405766OtherFIRST HEALTH PPO
CA1538405766OtherAETNA PPO
CA1538405766OtherBLUE CROSS BLUE SHIELD PPO
CA1538405766OtherMULTIPLAN PPO
CA1538405766OtherBLUE SHIELD PPO
CA1538405766OtherUNITED HEALTHCARE PPO